Provider Demographics
NPI:1871582684
Name:GILMER, RACHEL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:GILMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:BOSTIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:216 COLLEGE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9445
Mailing Address - Country:US
Mailing Address - Phone:276-964-7176
Mailing Address - Fax:276-964-7157
Practice Address - Street 1:495 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4510
Practice Address - Country:US
Practice Address - Phone:276-889-3700
Practice Address - Fax:276-889-5505
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005605687Medicaid
VA005605687Medicaid