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General NPI Number Information
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NPI Number | 1578909255
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Entity Type | Individual
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Provider Name | ALISHA ELAINE GILMORE NP
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Gender | Female
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 2710 S RIFE MEDICAL LN
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City | ROGERS
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State | AR
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Zip | 72758-1452
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Country | US
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Telephone | 479-636-0200
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Fax | 479-986-3448
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Provider Business Mailing Address
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Address Line | PO BOX 776084 PROVIDER ENROLLMENT
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 314-543-6979
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Fax | 314-364-6321
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 751586
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 751586
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP-02192
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP123194
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-02192
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License Number State | NM
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 222613
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License Number State | AR
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