Provider Demographics
NPI:1629246574
Name:GILLCOAT, CHARLSIE FERGUSON (ACNP-BC)
Entity type:Individual
Prefix:
First Name:CHARLSIE
Middle Name:FERGUSON
Last Name:GILLCOAT
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:CHARLSIE
Other - Middle Name:ELIZABETH
Other - Last Name:FERGUSON / PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:2221 H G MOSLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3670
Mailing Address - Country:US
Mailing Address - Phone:903-903-0903
Mailing Address - Fax:903-765-4437
Practice Address - Street 1:2221 H G MOSLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3670
Practice Address - Country:US
Practice Address - Phone:903-903-0903
Practice Address - Fax:903-765-4437
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116578363L00000X, 363LA2100X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193683302Medicaid
TX193683302Medicaid