Healthcare Provider Details

I. General information

NPI: 1366368201
Provider Name (Legal Business Name): KELLY GILMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 HILL GROVE AVE
COLUMBUS OH
43223-3644
US

IV. Provider business mailing address

3104 HILL GROVE AVE
COLUMBUS OH
43223-3644
US

V. Phone/Fax

Practice location:
  • Phone: 614-753-5386
  • Fax:
Mailing address:
  • Phone: 614-753-5386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: