Provider Demographics
NPI:1174892400
Name:GILLESPIE, RACHEL STEVENSON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:STEVENSON
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:SUZANNE
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:563 NEFF AVE STE A
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3765
Practice Address - Country:US
Practice Address - Phone:540-434-1756
Practice Address - Fax:540-434-1840
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110003895OtherVA STATE LICENSE
VA1174892400Medicaid
VA1174892400Medicaid