Provider Demographics
NPI:1821029489
Name:GILMORE, KATHERINE S (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:GILMORE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 LOOP RD
Mailing Address - Street 2:BLDG 5, SUITE 301
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2196
Mailing Address - Country:US
Mailing Address - Phone:937-438-5333
Mailing Address - Fax:937-438-0160
Practice Address - Street 1:6728 LOOP RD
Practice Address - Street 2:BLDG 5, SUITE 301
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2196
Practice Address - Country:US
Practice Address - Phone:937-438-5333
Practice Address - Fax:937-438-0160
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2840126Medicaid
OH2840126Medicaid