Provider Demographics
NPI:1174929277
Name:GILLS, JESSICA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GILLS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2970
Mailing Address - Country:US
Mailing Address - Phone:504-353-5502
Mailing Address - Fax:
Practice Address - Street 1:3020 KINGMAN ST
Practice Address - Street 2:STE B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6673
Practice Address - Country:US
Practice Address - Phone:504-353-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily