Healthcare Provider Details

I. General information

NPI: 1346681020
Provider Name (Legal Business Name): TUNDIKE GORE DNP, PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TUNDE GORE

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 10/07/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 RIVER RD N STE B
KEIZER OR
97303-5324
US

IV. Provider business mailing address

1614 MINERAL SPRINGS DR
ALLEN TX
75002-0616
US

V. Phone/Fax

Practice location:
  • Phone: 972-765-7168
  • Fax:
Mailing address:
  • Phone: 972-765-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP123999
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202109011NP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number20211168NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: