Provider Demographics
NPI:1679123285
Name:ELMORE, CHERYL LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:ELMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 SOUTHWEST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3964
Mailing Address - Country:US
Mailing Address - Phone:817-989-1221
Mailing Address - Fax:817-989-1175
Practice Address - Street 1:6100 SOUTHWEST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3964
Practice Address - Country:US
Practice Address - Phone:817-989-1221
Practice Address - Fax:817-989-1175
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily