Provider Demographics
NPI:1952991846
Name:ELMORE, MIAH KIRBY (RN)
Entity Type:Individual
Prefix:
First Name:MIAH
Middle Name:KIRBY
Last Name:ELMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 COLONIAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3924
Mailing Address - Country:US
Mailing Address - Phone:931-879-9936
Mailing Address - Fax:931-879-9938
Practice Address - Street 1:240 COLONIAL CIR STE A
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3924
Practice Address - Country:US
Practice Address - Phone:931-879-9936
Practice Address - Fax:931-879-9938
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000185879163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000185879OtherNURSE LICENSURE NUMBER