MEDICARE: MARY PATRICE ELMORE RNC, WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	AP110878	TX

General Provider Information

NPI Number	:	1407838998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY PATRICE ELMORE RNC, WHNP

Provider Business Mailing Address
First Line	:	5219 CITY BANK PKWY
Second Line	:	SUITE 135
City	:	LUBBOCK
State	:	TX
Zip	:	79407-3544
Country	:	US
Telephone Number	:	806-761-0333
Fax Number	:	806-722-2908

Provider Business Practice Location Address
First Line	:	808 JOLIET AVE UNIT 110
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79415-1148
Country	:	US
Telephone Number	:	68-761-0545
Fax Number	:	806-761-0546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	09/27/2018

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