Healthcare Provider Details

I. General information

NPI: 1861988156
Provider Name (Legal Business Name): HALEY S GORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 N BROTHER BLVD STE 100
BARTLETT TN
38133-2760
US

IV. Provider business mailing address

8110 N BROTHER BLVD STE 200
BARTLETT TN
38133-2760
US

V. Phone/Fax

Practice location:
  • Phone: 901-373-9221
  • Fax: 901-202-5995
Mailing address:
  • Phone: 901-255-5221
  • Fax: 901-373-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24553
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: