MEDICARE: MRS. ANNA GORE MS, RD, LDN

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	133V00000X	Registered Dietitian	L003190	NC

General Provider Information

NPI Number	:	1598066961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA GORE MS, RD, LDN

Provider Business Mailing Address
First Line	:	94 N LAKES DR
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-4402
Country	:	US
Telephone Number	:	910-770-7339
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 N LAKES DR
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-4402
Country	:	US
Telephone Number	:	910-770-7339
Fax Number	:

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

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	03/10/2025

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