Kanitra Elmore
Individual provider Active NPI Registered Nurse · Lake Providence, LA
NPI 1962995688 · NPPES record last updated Jun 7, 2018
Key facts
- NPI
- 1962995688
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 111966 (LA)
- Practice address
- 202 Lake St
Lake Providence, LA 71254-2628 - Phone
- (318) 552-5126
- Fax
- (318) 552-5127
- NPI assigned
- Jun 7, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111966 | LA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Changing Lives Counseling and Mentoring, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 111966 | LA | Yes |
Addresses
Primary practice location
202 Lake St
Lake Providence, LA 71254-2628
Mailing address
2984 Highway 80 W Lot 58
Calhoun, LA 71225-7915
Phone (318) 552-5126
Other providers in Lake Providence, LA
- East Carroll Parish Hospital
- East Carroll Parish Hospital
- East Carroll Parish Hospital
- East Carroll Parish School Board
- East Carroll Parish School District
- George Fakhre
- Ann Sullivan Fautheree
- Sade' Finley
- Savannah Fortenberry
- Fred'S Pharmacy #3958
All providers in Lake Providence, LA · Registered Nurse in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.