Provider Demographics
NPI:1679559884
Name:GILLILAND, GINA R (RNCWHNP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:RNCWHNP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:R
Other - Last Name:WEST
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:RNCWHNP
Mailing Address - Street 1:800 WEST JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3557
Mailing Address - Country:US
Mailing Address - Phone:660-626-2036
Mailing Address - Fax:660-626-2038
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-626-2036
Practice Address - Fax:660-626-2038
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120873363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429780414Medicaid
MO429780414Medicaid
MO824291740Medicare PIN