Provider Demographics
NPI:1437678554
Name:WILMORE, ELIZABETH KAY ELSEA (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY ELSEA
Last Name:WILMORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2368
Mailing Address - Country:US
Mailing Address - Phone:931-528-1485
Mailing Address - Fax:
Practice Address - Street 1:150 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2368
Practice Address - Country:US
Practice Address - Phone:931-528-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant