Provider Demographics
NPI:1235765033
Name:ELMORE, KENNEDY MONEE BURSEY
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:MONEE BURSEY
Last Name:ELMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 PRIMROSE RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1223
Mailing Address - Country:US
Mailing Address - Phone:202-812-0681
Mailing Address - Fax:
Practice Address - Street 1:1429 PRIMROSE RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1223
Practice Address - Country:US
Practice Address - Phone:202-812-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician