Provider Demographics
NPI:1255735999
Name:GILLIAM, REBECCA R (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7142 SAN PEDRO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6255
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-481-3116
Practice Address - Street 1:18707 HARDY OAK BLVD STE 530
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4791
Practice Address - Country:US
Practice Address - Phone:210-495-8280
Practice Address - Fax:210-481-3116
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126539363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology