Provider Demographics
NPI:1346681020
Name:GORE, TUNDIKE (DNP, PMHNP, FNP)
Entity Type:Individual
Prefix:
First Name:TUNDIKE
Middle Name:
Last Name:GORE
Suffix:
Gender:F
Credentials:DNP, PMHNP, FNP
Other - Prefix:
Other - First Name:TUNDE
Other - Middle Name:
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1614 MINERAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-0616
Mailing Address - Country:US
Mailing Address - Phone:972-765-7168
Mailing Address - Fax:
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:972-765-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123999363LF0000X
OR202109011NP-PP363LF0000X
OR20211168NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP-C NUMBER: F061387OtherNP-C NUMBER: F0613870