Provider Demographics
NPI:1669299889
Name:THE903NP
Entity type:Organization
Organization Name:THE903NP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLSIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GILLCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, ACNP-BC
Authorized Official - Phone:903-903-0903
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty