Provider Demographics
NPI:1780998559
Name:GILLESPIE, JASON M (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:M
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 FIRETHORN DR
Mailing Address - Street 2:
Mailing Address - City:TREYNOR
Mailing Address - State:IA
Mailing Address - Zip Code:51575-5010
Mailing Address - Country:US
Mailing Address - Phone:712-355-1530
Mailing Address - Fax:
Practice Address - Street 1:5062 S 155TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-5040
Practice Address - Country:US
Practice Address - Phone:402-810-9494
Practice Address - Fax:402-810-9498
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-126699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily