Provider Demographics
NPI:1306331970
Name:GORE, KJERSTEN (LPN)
Entity type:Individual
Prefix:
First Name:KJERSTEN
Middle Name:
Last Name:GORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 15TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1672
Mailing Address - Country:US
Mailing Address - Phone:253-376-2382
Mailing Address - Fax:
Practice Address - Street 1:4012 WIGGINS RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4372
Practice Address - Country:US
Practice Address - Phone:360-491-1036
Practice Address - Fax:360-491-1416
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60839655164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse