Doctor Name: | KRISTIN ELMORE |
NPI Number: | 1245613058 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 209012890 |
Business Practice Address: | 270 Maple Summit Road Jerseyville, IL - 620522028 |
Business Phone Number: | 6184982273 |
Business Fax Number: | 6186398000 |
Mailing Address: | 390 Maple Summit Rd, JERSEYVILLE |
State: | IL |
Postal Code: | 620522000 |
Phone Number: | 6184987518 |
Fax Number: | 6184983052 |
NPI Enumeration Date: | 06/30/2015 |
NPI Last Update Date: | 06/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209012890 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |