Provider Demographics
NPI:1710124185
Name:BARBARA A. GILMORE, PMH, NP, BC
Entity Type:Organization
Organization Name:BARBARA A. GILMORE, PMH, NP, BC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PMH, NP, BC
Authorized Official - Phone:575-521-3388
Mailing Address - Street 1:1401 S DON ROSER DR STE F2
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4577
Mailing Address - Country:US
Mailing Address - Phone:575-521-3388
Mailing Address - Fax:575-521-4023
Practice Address - Street 1:1401 S DON ROSER DR STE F2
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4577
Practice Address - Country:US
Practice Address - Phone:575-521-3388
Practice Address - Fax:575-521-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36659163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36024538Medicaid
NM36024538Medicaid