Provider Demographics
NPI:1205492592
Name:ELMORE, BETH A (HIS)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:ELMORE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BEAVER RUN CV
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-3831
Mailing Address - Country:US
Mailing Address - Phone:731-345-0388
Mailing Address - Fax:
Practice Address - Street 1:2021 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3576
Practice Address - Country:US
Practice Address - Phone:731-668-3165
Practice Address - Fax:731-668-9860
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000947237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist