Provider Demographics
NPI:1811531817
Name:GILMER, CHRISTY DIANE (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:DIANE
Last Name:GILMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CULLY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5950
Mailing Address - Country:US
Mailing Address - Phone:830-258-6300
Mailing Address - Fax:830-515-5485
Practice Address - Street 1:250 CULLY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5950
Practice Address - Country:US
Practice Address - Phone:830-258-6300
Practice Address - Fax:830-515-5485
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX405694701Medicaid