MEDICARE: JULIE EILEEN GORE AGNP-C

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	363LG0600X	Gerontology Nurse Practitioner	5020865	NC
2	363LA2200X	Adult Health Nurse Practitioner	5020865	NC
3	163WG0000X	General Practice Registered Nurse	371936	NC

General Provider Information

NPI Number	:	1851127617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE EILEEN GORE AGNP-C

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	FAISON
State	:	NC
Zip	:	28341-0187
Country	:	US
Telephone Number	:	910-267-2042
Fax Number	:	855-996-9090

Provider Business Practice Location Address
First Line	:	110 EASTWOOD DR
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-9201
Country	:	US
Telephone Number	:	910-285-2330
Fax Number	:	910-320-8429

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

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	01/27/2026

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