Provider Demographics
NPI:1588770804
Name:GILLMAN, PAULA HARRISON (NP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:HARRISON
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GASTON AVE
Mailing Address - Street 2:4 ROBERTS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2017
Mailing Address - Country:US
Mailing Address - Phone:214-820-3000
Mailing Address - Fax:
Practice Address - Street 1:12221 MERIT DR
Practice Address - Street 2:SUITE 1610
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2202
Practice Address - Country:US
Practice Address - Phone:972-372-0912
Practice Address - Fax:214-217-1901
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521941363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140902106Medicaid
TXP00256840OtherRR MEDICARE
TX140902103Medicaid
TX140902105Medicaid
TX1409021-06Medicaid
TX081425302OtherMEDICAID GROUP
TX140902104Medicaid
TX8K1249Medicare PIN
TX8K1241Medicare PIN
TX140902104Medicaid
TX8K1242Medicare PIN
TXTXB158116Medicare PIN
TXS52598Medicare UPIN