Provider Demographics
NPI:1942831201
Name:GILLIAM, AUDREY S (MSN, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:S
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 W HIGHWAY 105 # 256
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9125
Mailing Address - Country:US
Mailing Address - Phone:719-719-1233
Mailing Address - Fax:
Practice Address - Street 1:9362 GRAND CORDERA PKWY STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7014
Practice Address - Country:US
Practice Address - Phone:719-719-1233
Practice Address - Fax:833-428-4409
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999108-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics