Healthcare Provider Details

I. General information

NPI: 1598069445
Provider Name (Legal Business Name): KATHIE DIANE ELMORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHIE DIANE LAFOLLETTE NP

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SULPHUR SPRINGS RD
GREENVILLE SC
29617-1621
US

IV. Provider business mailing address

4 WOODVIEW CT
TAYLORS SC
29687-4508
US

V. Phone/Fax

Practice location:
  • Phone: 800-375-5495
  • Fax: 800-564-5952
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.4212
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number4212
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: