Provider Demographics
NPI:1588834246
Name:GILMORE, CARLEEN KAY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CARLEEN
Middle Name:KAY
Last Name:GILMORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N OBER ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2439
Mailing Address - Country:US
Mailing Address - Phone:785-483-3030
Mailing Address - Fax:
Practice Address - Street 1:109 N OBER ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2439
Practice Address - Country:US
Practice Address - Phone:785-483-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily