Provider Demographics
NPI:1124094529
Name:GILMORE, LORETTA M (CRNA)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:GILMORE
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:M
Other - Last Name:GAITHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3549
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-0549
Mailing Address - Country:US
Mailing Address - Phone:423-698-3309
Mailing Address - Fax:423-624-6355
Practice Address - Street 1:10415 WALLACE ALLEY ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3936
Practice Address - Country:US
Practice Address - Phone:423-390-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135808367500000X
TNRN114674367500000X
TNAPN10167367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3062499OtherBCBS
TN3625747Medicaid
KYK221791OtherMEDICARE
TN3625747Medicare UPIN
TN3625747Medicaid