Individual provider Active NPI

Jaclyn P Gilliam, CNM

  • Advanced Practice Midwife
  • Longview, TX
National Provider Identifier
1154483113
Registry record updated Aug 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
AP109416 Issued in TX
Practice address
1761 W Loop 281
Longview, TX 75604-2734
Phone
(903) 758-2610
Fax
(903) 758-7081
NPI assigned
Dec 15, 2006
Last updated
Aug 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X AP109416 TX Primary

Addresses

Primary practice location

1761 W Loop 281
Longview, TX 75604-2734

Mailing address

1107 E Marshall Ave
Longview, TX 75601-5602
Phone (903) 675-8261

Other practice location 1

705 E Marshall Ave Ste 3000
Longview, TX 75601-5661
Phone (903) 758-2610

Other practice location 2

1107 E Marshall Ave
Longview, TX 75601-5602
Phone (903) 758-2610

Other practice location 3

802 Medical Dr Ste 101
Longview, TX 75605-5169
Phone (903) 758-2610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071005000428 TX Practitioner - Certified Nurse Midwife (CNM) 7911960117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
University of Texas Medical Branch at Galveston, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Longview Wellness Center IncGroup PAC ID 1254367766, 22 clinicians

Practice addresses (Care Compare)

1761 W Loop
Suite 281
Longview, TX 75604-2734
Phone (903) 758-2610

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
AP109416TXMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Longview Wellness Center, Inc CurrentSince Aug 24, 2013 Accepting new patients
Tyler Family Circle of Care Current Accepting new patients
Longview Wellness Center Inc CurrentSince Aug 24, 2013 Accepting new patients
Longview Wellness Center, Inc Current Accepting new patients
Longview Wellness Center Inc PastSince Jan 2, 2022 Accepting new patients

Locations

1107 E Marshall Ave
Longview, TX 75601
Phone (903) 212-4763

1701 Pine Tree Rd
Longview, TX 75604
Phone (713) 292-3177

1761 W Loop 281
Longview, TX 75604
Phone (903) 297-1733

705 E Marshall Ave
Ste 3000
Longview, TX 75601
Phone (903) 230-2608

802 Medical Cir
Ste 101
Longview, TX 75605
Phone (903) 753-7658

214 E Houston St
Tyler, TX 75702
Phone (903) 593-1892

523 S Fannin Ave
Tyler, TX 75702

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Interoperability endpoints

  • Direct secure messaging: paigegilliam@wp.medalliesdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1154483113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015602",
            "telephone_number": "903-675-8261",
            "fax_number": "903-758-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 W LOOP 281",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756042734",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 E Marshall Ave Ste 3000",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015661",
            "country_code": "US",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1107 E Marshall Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015602",
            "country_code": "US",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-3124",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "802 Medical Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756055169",
            "country_code": "US",
            "telephone_number": "903-758-2610",
            "fax_number": "903-758-7081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "JACLYN",
        "middle_name": "P",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "TX",
            "license": "AP109416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.