Provider Demographics
NPI:1407838998
Name:ELMORE, MARY PATRICE (RNC, WHNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-722-2908
Practice Address - Street 1:808 JOLIET AVE UNIT 110
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1148
Practice Address - Country:US
Practice Address - Phone:068-761-0545
Practice Address - Fax:806-761-0546
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110878363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health