MEDICARE: KATHIE DIANE ELMORE NP

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	363L00000X	Nurse Practitioner	APN.4212	SC
2	207VH0002X	Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician	4212	SC

General Provider Information

NPI Number	:	1598069445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHIE DIANE ELMORE NP

Provider Business Mailing Address
First Line	:	4 WOODVIEW CT
Second Line	:
City	:	TAYLORS
State	:	SC
Zip	:	29687-4508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 SULPHUR SPRINGS RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1621
Country	:	US
Telephone Number	:	800-375-5495
Fax Number	:	800-564-5952

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

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	08/02/2021

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