Provider Demographics
NPI:1538798087
Name:GORE, GLENDA DARLENE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:DARLENE
Last Name:GORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032
Mailing Address - Country:US
Mailing Address - Phone:501-900-4549
Mailing Address - Fax:484-328-6447
Practice Address - Street 1:719 FRONT STREET
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-900-4549
Practice Address - Fax:484-328-6447
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily