Provider Demographics
NPI:1588985915
Name:GILMORE, KAMEESHIA LATOYA (LPN)
Entity type:Individual
Prefix:MRS
First Name:KAMEESHIA
Middle Name:LATOYA
Last Name:GILMORE
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 1:62 JUDITH DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4063
Mailing Address - Country:US
Mailing Address - Phone:163-156-9657
Mailing Address - Fax:
Practice Address - Street 1:62 JUDITH DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4063
Practice Address - Country:US
Practice Address - Phone:163-156-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299471-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse