Provider Demographics
NPI:1285841270
Name:ELMORE, JILL CASON (CNRP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CASON
Last Name:ELMORE
Suffix:
Gender:F
Credentials:CNRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MEDICAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1103
Mailing Address - Country:US
Mailing Address - Phone:334-222-1366
Mailing Address - Fax:334-222-1150
Practice Address - Street 1:301 MEDICAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-1103
Practice Address - Country:US
Practice Address - Phone:334-222-1366
Practice Address - Fax:334-222-1150
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-069423OtherAL LICENSE
AL511-62253OtherBCBS
1-069423OtherAL LICENSE