Elizabeth Kay Elsea Wilmore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3424 Issued in TN

Practice address

150 N Willow Ave
Cookeville, TN 38501-2368

Phone

(931) 528-1485

NPI assigned

Sep 11, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cookeville Pediatric Associates, PLLC

  • Pediatrics Physician
  • Cookeville, TN
  • NPI 1538173471
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1437678554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012368",
            "telephone_number": "931-528-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012368",
            "telephone_number": "931-528-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILMORE",
        "first_name": "ELIZABETH",
        "middle_name": "KAY ELSEA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina A Williams, LMFTA
• Matilyn Brook Williams
• Richard Irwin Williams, M.D.
• Kayce Elizabeth Williamson, OTR/L
• Robyn Lynn Willis, L.P.C.
• Kasandra Kay Wilmore, CCRN
• Lisa Wilmoth, MA
• Bradford Taylor Wilson
• Brett M Wilson, APRN
• Carolyn Wilson, BCBA

• Physician Assistant in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.