Provider Demographics
NPI:1205272259
Name:GILMORE, LISA ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:GILMORE
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 1:2820 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2361
Mailing Address - Country:US
Mailing Address - Phone:316-775-7500
Mailing Address - Fax:316-775-3685
Practice Address - Street 1:2820 OHIO ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010
Practice Address - Country:US
Practice Address - Phone:316-775-7500
Practice Address - Fax:316-775-3685
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75955363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102644005OtherIND PTAN
KS30004237450001Medicaid
KS1891730339OtherGRP NPI
KS102644OtherGRP PTAN
KS1205272259OtherIND NPI