| Doctor Name: | MISTY A. GILLILAND |
| NPI Number: | 1003215500 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 18883 |
| Business Practice Address: | 979 E 3rd St Suite B601 Chattanooga, TN - 374032136 |
| Business Phone Number: | 4237788566 |
| Business Fax Number: | 4237785736 |
| Mailing Address: | 975 E 3rd St, Attn: Provider Enrollment CHATTANOOGA |
| State: | TN |
| Postal Code: | 374032147 |
| Phone Number: | 4237785630 |
| Fax Number: | 4237783146 |
| NPI Enumeration Date: | 08/20/2014 |
| NPI Last Update Date: | 10/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 18883 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |