Provider Demographics
NPI:1598069445
Name:ELMORE, KATHIE DIANE (NP)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:DIANE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHIE
Other - Middle Name:DIANE
Other - Last Name:LAFOLLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4 WOODVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-1621
Practice Address - Country:US
Practice Address - Phone:800-375-5495
Practice Address - Fax:800-564-5952
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.4212363L00000X
SC4212207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner