Healthcare Provider Details

I. General information

NPI: 1164194429
Provider Name (Legal Business Name): LAURA GENEVA GILMER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 AVALON AVE
MUSCLE SHOALS AL
35661-2804
US

IV. Provider business mailing address

210 AVALON AVE
MUSCLE SHOALS AL
35661-2804
US

V. Phone/Fax

Practice location:
  • Phone: 256-826-1001
  • Fax: 256-978-5118
Mailing address:
  • Phone: 256-826-1001
  • Fax: 256-978-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-124928
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-124928
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-124928
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: