Provider Demographics
NPI:1952877177
Name:GILLIAM, RACHEL (APRN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-4312
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:BLDG B, STE 255
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7676
Practice Address - Country:US
Practice Address - Phone:859-744-2623
Practice Address - Fax:859-744-9421
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3012659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100557170Medicaid