Provider Demographics
NPI:1184430308
Name:GILMORE, BRANDON S (ARNP PMHNP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:S
Last Name:GILMORE
Suffix:
Gender:M
Credentials:ARNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2812
Mailing Address - Country:US
Mailing Address - Phone:563-528-2069
Mailing Address - Fax:
Practice Address - Street 1:770 TANGLEFOOT LN
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1608
Practice Address - Country:US
Practice Address - Phone:563-241-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG182333363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health