Basic Information
| Provider Information | |||||||||
| NPI: | 1710124185 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARBARA A. GILMORE, PMH, NP, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 S DON ROSER DR STE F2 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880114577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755213388 | ||||||||
| FaxNumber: | 5755214023 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 S DON ROSER DR STE F2 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880114577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755213388 | ||||||||
| FaxNumber: | 5755214023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2009 | ||||||||
| LastUpdateDate: | 01/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | GILMORE | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5755213388 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PMH, NP, BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | R36659 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 36024538 | 05 | NM | MEDICAID |