Provider Demographics
NPI:1184293839
Name:GILLESPY, KRISTEN SUZANNE (PA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:GILLESPY
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:250 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6504
Mailing Address - Country:US
Mailing Address - Phone:386-212-8157
Mailing Address - Fax:
Practice Address - Street 1:740 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3282
Practice Address - Country:US
Practice Address - Phone:386-734-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-11-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant