Healthcare Provider Details

I. General information

NPI: 1275102709
Provider Name (Legal Business Name): NATALIE J. GILMORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE A JURISICH

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2605
  • Fax: 337-470-4595
Mailing address:
  • Phone: 337-470-2605
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number341172
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: