Provider Demographics
NPI:1285336966
Name:GILMORE, LASHANDRA MAE (NP)
Entity type:Individual
Prefix:MRS
First Name:LASHANDRA
Middle Name:MAE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 CENTERVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1440
Mailing Address - Country:US
Mailing Address - Phone:210-748-7366
Mailing Address - Fax:
Practice Address - Street 1:19284 STONE OAK PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3474
Practice Address - Country:US
Practice Address - Phone:210-268-0120
Practice Address - Fax:210-268-0170
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084164363L00000X, 163WG0000X
TXF03230522363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice