Provider Demographics
NPI:1114563343
Name:GILMORE, PATRICIA A (RDA, AUXILIARY)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GILMORE
Suffix:
Gender:F
Credentials:RDA, AUXILIARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W INTERSTATE 30 APT 1023
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-7562
Mailing Address - Country:US
Mailing Address - Phone:214-694-1051
Mailing Address - Fax:972-692-6918
Practice Address - Street 1:7000 W INTERSTATE 30 APT 1023
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-7562
Practice Address - Country:US
Practice Address - Phone:214-694-1051
Practice Address - Fax:972-692-6918
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX834262189Medicaid