Provider Demographics
NPI:1639331010
Name:ELMORE, WHITNEY DAWN (BA)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:DAWN
Last Name:ELMORE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 SOUTH COMMERCE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-0189
Mailing Address - Country:US
Mailing Address - Phone:580-223-5636
Mailing Address - Fax:580-226-6727
Practice Address - Street 1:2530 SOUTH COMMERCE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-0189
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:580-226-6727
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator