Provider Demographics
NPI:1053128892
Name:KERSTIN GILLESPIE LLC
Entity type:Organization
Organization Name:KERSTIN GILLESPIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KERSTIN
Authorized Official - Middle Name:HOLL
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:512-566-0448
Mailing Address - Street 1:14875 W STATE HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4294
Mailing Address - Country:US
Mailing Address - Phone:512-566-0448
Mailing Address - Fax:512-566-0449
Practice Address - Street 1:14875 W STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4294
Practice Address - Country:US
Practice Address - Phone:512-566-0448
Practice Address - Fax:512-566-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty