Provider Demographics
NPI:1194431569
Name:GILMORE, BRANDII JENNIFER
Entity type:Individual
Prefix:MRS
First Name:BRANDII
Middle Name:JENNIFER
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5490 MINNER DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-4511
Mailing Address - Country:US
Mailing Address - Phone:409-679-8020
Mailing Address - Fax:
Practice Address - Street 1:5490 MINNER DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-4511
Practice Address - Country:US
Practice Address - Phone:409-679-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator