Provider Demographics
NPI:1902434434
Name:WHITE, GILLIAN GATEWOOD
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:GATEWOOD
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 ARAPAHO RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7900
Mailing Address - Country:US
Mailing Address - Phone:432-366-9555
Mailing Address - Fax:
Practice Address - Street 1:2650 ARAPAHO RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7900
Practice Address - Country:US
Practice Address - Phone:432-366-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86002444133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty