Healthcare Provider Details

I. General information

NPI: 1285966739
Provider Name (Legal Business Name): COLLEEN R GILMORE AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV IM HOSPITALIST
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8058
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1700
  • Fax: 314-362-9878
Mailing address:
  • Phone: 314-362-1700
  • Fax: 314-362-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209017441
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2009038222
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2009038222
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: