Provider Demographics
NPI:1710963186
Name:SIMKO, ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:SIMKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 3A112
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-4237
Practice Address - Fax:806-743-2113
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89N110OtherBC/BS
NMN6198Medicaid
TX85758ZOtherHMO BLUE
NMC002OtherTRIWEST
TXP48870Medicare UPIN
TX89N110OtherBC/BS