Provider Demographics
NPI:1326296906
Name:ELMORE, ANGELA D (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:ELMORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15702 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7675
Mailing Address - Country:US
Mailing Address - Phone:316-305-8529
Mailing Address - Fax:316-305-8529
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-701-4555
Practice Address - Fax:816-701-4556
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46197363LN0000X
MO2009036101363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal