Provider Demographics
NPI:1528798295
Name:GILMORE, CASEY RICHARD (LPN)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:RICHARD
Last Name:GILMORE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W NEW HOPE RD APT C8
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-7561
Mailing Address - Country:US
Mailing Address - Phone:910-273-4819
Mailing Address - Fax:
Practice Address - Street 1:1700 E ASH ST STE 201
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4097
Practice Address - Country:US
Practice Address - Phone:919-736-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87552164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse