Provider Demographics
NPI:1356932446
Name:GILLIAM, JESSICA LOUISE (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 COUNSELORS ROW STE 210
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6418
Mailing Address - Country:US
Mailing Address - Phone:317-429-0120
Mailing Address - Fax:317-800-7730
Practice Address - Street 1:9033 N MIAMI RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4675
Practice Address - Country:US
Practice Address - Phone:812-341-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28190353A163W00000X
NV878259363L00000X, 363LF0000X
CA95030610363L00000X
UT13378758-4405363LF0000X
MTAPRN-215721363LF0000X
COC-APN.0002568-C-NP363LF0000X
AZ295793363LF0000X
ID76235363LF0000X
WAAP61173718363LF0000X
NM73567363LF0000X
TX1138183363LF0000X
IN71010781A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner