Provider Demographics
NPI:1669299889
Name:THE903NP
Entity type:Organization
Organization Name:THE903NP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLSIE
Authorized Official - Middle Name:FERGUSON
Authorized Official - Last Name:GILLCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:903-903-0903
Mailing Address - Street 1:2828 4TH ST # 100
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5718
Mailing Address - Country:US
Mailing Address - Phone:903-903-0903
Mailing Address - Fax:903-213-9045
Practice Address - Street 1:2828 4TH ST # 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5718
Practice Address - Country:US
Practice Address - Phone:903-903-0903
Practice Address - Fax:903-213-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2025-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty