Healthcare Provider Details

I. General information

NPI: 1154857985
Provider Name (Legal Business Name): STACIE GILMORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 LEDFORD ST
MURPHY NC
28906-6213
US

IV. Provider business mailing address

183 LEDFORD ST
MURPHY NC
28906-6213
US

V. Phone/Fax

Practice location:
  • Phone: 828-837-4712
  • Fax: 828-837-4808
Mailing address:
  • Phone: 828-837-4712
  • Fax: 828-837-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201902478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: