Provider Demographics
NPI:1275345522
Name:GILMORE, AMANDA K
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
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 1:1400 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-2210
Mailing Address - Country:US
Mailing Address - Phone:308-535-7126
Mailing Address - Fax:
Practice Address - Street 1:1400 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-2210
Practice Address - Country:US
Practice Address - Phone:308-535-7126
Practice Address - Fax:308-535-5303
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67027163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool