Jaclyn P Gilliam, CNM

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

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

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)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

Interoperability endpoints

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

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

• Longview Wellness Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1942269493

  TX

  Medicare reassignment Care Compare group NPD
• Longview Wellness Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1023426665
  Care Compare group NPD
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1093470221
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1093491243
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1417779554
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Tyler, TX
  • NPI 1558957662
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1578369922
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1629890801
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1699571091
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1740065473
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1770358582
  Care Compare group
• Longview Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Mt Pleasant, TX
  • NPI 1821633033
  Care Compare group

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124101006",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124101005",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry Jack Gilbert, LPC, LMFT, LSSP
• Hayley Gill, RN
• Brenda Gillar, CCC/SLP
• Charlsie Ferguson Gillcoat, ACNP-BC
• Cheryl Diane Gilliam, R.PH.
• Kelly Sue Gilmer, LPC
• Romesha M Gines, LVN
• Debra Lynn Glenn, LCSW
• Rikki Laray Glezen, FNP-C
• Sandra Glezen

• All providers in Longview, TX
• Advanced Practice Midwife in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.