Healthcare Provider Details

I. General information

NPI: 1831019934
Provider Name (Legal Business Name): ALEXIS GORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E BROADWAY ST
CUSHING OK
74023-3511
US

IV. Provider business mailing address

1107 E BROADWAY ST
CUSHING OK
74023-3511
US

V. Phone/Fax

Practice location:
  • Phone: 430-333-0061
  • Fax:
Mailing address:
  • Phone: 430-333-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: