Provider Demographics
NPI:1912629049
Name:GILLESPIE, KRISTIE M (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1728
Mailing Address - Country:US
Mailing Address - Phone:916-605-9390
Mailing Address - Fax:
Practice Address - Street 1:28 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-6069
Practice Address - Country:US
Practice Address - Phone:540-835-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily