Healthcare Provider Details

I. General information

NPI: 1710124185
Provider Name (Legal Business Name): BARBARA A. GILMORE, PMH, NP, BC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S DON ROSER DR STE F2
LAS CRUCES NM
88011-4577
US

IV. Provider business mailing address

1401 S DON ROSER DR STE F2
LAS CRUCES NM
88011-4577
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-3388
  • Fax: 575-521-4023
Mailing address:
  • Phone: 575-521-3388
  • Fax: 575-521-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR36659
License Number StateNM

VIII. Authorized Official

Name: BARBARA A. GILMORE
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMH, NP, BC
Phone: 575-521-3388