Healthcare Provider Details

I. General information

NPI: 1982942488
Provider Name (Legal Business Name): MICHAEL LEE GILMORE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

IV. Provider business mailing address

1326 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

V. Phone/Fax

Practice location:
  • Phone: 865-330-6320
  • Fax:
Mailing address:
  • Phone: 865-330-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number207QG0300X
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: