Provider Demographics
NPI:1811098106
Name:GORE, DENISE ANN (FNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:GORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:GORE-KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:333 BEACON HILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-6182
Mailing Address - Country:US
Mailing Address - Phone:606-780-0444
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:333 BEACON HILL RD STE 201
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-6182
Practice Address - Country:US
Practice Address - Phone:606-780-0444
Practice Address - Fax:606-784-2344
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201537363LF0000X
KY2171P363LF0000X
KY3002171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041783Medicaid
KY78021714Medicaid
KY78021714Medicaid
KY0055664Medicare PIN