MEDICARE: MRS. MADISON LOUANNE GILMORE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA14704	TX

General Provider Information

NPI Number	:	1326618398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADISON LOUANNE GILMORE PA-C

Provider Business Mailing Address
First Line	:	5A RHEA MILLS CIR
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-9136
Country	:	US
Telephone Number	:	214-491-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 VIRGINIA PKWY STE 102
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5410
Country	:	US
Telephone Number	:	972-548-0333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	01/10/2022

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