Provider Demographics
NPI:1710375050
Name:GORE, CHERYL R (APRN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:GORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 LAURELWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6008
Mailing Address - Country:US
Mailing Address - Phone:270-599-2419
Mailing Address - Fax:833-471-3546
Practice Address - Street 1:855 LOVERS LN STE 106
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7989
Practice Address - Country:US
Practice Address - Phone:270-938-5765
Practice Address - Fax:833-471-3546
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010003363LP0808X
KY3009103363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100346680Medicaid
KYK134451Medicare PIN
KYK134451Medicare PIN