Provider Demographics
NPI:1245077833
Name:GILMORE, RACHELLE LEA (FNP)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LEA
Last Name:GILMORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:LEA
Other - Last Name:BROOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 W ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1786
Mailing Address - Country:US
Mailing Address - Phone:770-867-6633
Mailing Address - Fax:
Practice Address - Street 1:133 W ATHENS ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1786
Practice Address - Country:US
Practice Address - Phone:770-867-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily