Provider Demographics
NPI:1104253699
Name:GILLILAND, ASHLEY CARPENTER (ANP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CARPENTER
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 S GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6343
Mailing Address - Country:US
Mailing Address - Phone:662-844-9166
Mailing Address - Fax:662-844-0170
Practice Address - Street 1:961 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6343
Practice Address - Country:US
Practice Address - Phone:662-844-9166
Practice Address - Fax:662-844-0170
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR895264363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health