Healthcare Provider Details

I. General information

NPI: 1093238800
Provider Name (Legal Business Name): LISA ANN ELMORE NBC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S BOLGER RD
INDEPENDENCE MO
64055-6772
US

IV. Provider business mailing address

9551 N FARM ROAD 203
FAIR GROVE MO
65648-8205
US

V. Phone/Fax

Practice location:
  • Phone: 816-216-5665
  • Fax:
Mailing address:
  • Phone: 417-830-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2013040405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: