Provider Demographics
NPI:1710662325
Name:GILMORE, KAREN MARIE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 TWILIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5752
Mailing Address - Country:US
Mailing Address - Phone:850-532-7361
Mailing Address - Fax:
Practice Address - Street 1:415 N RICHARD JACKSON BLVD STE 209
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3694
Practice Address - Country:US
Practice Address - Phone:850-532-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-279793106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician