MEDICARE: MRS. JACQUELYN GILMORE

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	374U00000X	Home Health Aide	HHA15500	DC

General Provider Information

NPI Number	:	1508585043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELYN GILMORE

Provider Business Mailing Address
First Line	:	3800 14TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-5458
Country	:	US
Telephone Number	:	202-590-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 LENFANT PLZ SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20024-2119
Country	:	US
Telephone Number	:	202-282-3110
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/26/2022

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Directions to “ MRS. JACQUELYN GILMORE ” Practice Location

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