MEDICARE: KINSEY GILMORE MS, LD/N, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	9842	FL
2	174N00000X	Lactation Consultant (Non-RN)	302521

General Provider Information

NPI Number	:	1306613435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINSEY GILMORE MS, LD/N, IBCLC

Provider Business Mailing Address
First Line	:	5198 CLUBHOUSE DR
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446-0141
Country	:	US
Telephone Number	:	850-228-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	5198 CLUBHOUSE DR
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446-0141
Country	:	US
Telephone Number	:	850-228-3883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	03/26/2026

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