Provider Demographics
NPI:1598066961
Name:GORE, ANNA (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:GORE
Suffix:
Gender:
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 N LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4402
Mailing Address - Country:US
Mailing Address - Phone:910-770-7339
Mailing Address - Fax:
Practice Address - Street 1:94 N LAKES DR
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4402
Practice Address - Country:US
Practice Address - Phone:910-770-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered