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Individual
JACKLYN MARIE ELMER
Active
Individual
JACKLYN MARIE ELMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06585
TX
363A00000X
Physician Assistant
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
321033801
—
TX
01
—
816N94
BCBS
TX
01
—
835N10
BC/BS TX - EFFECT 02/01/2011
TX
01
—
P00935316
RAILROAD MEDICARE
TX
01
—
PA06585
TX MEDICAL LICENSE
TX
01
—
TXB121235
MEDICARE PART B - EFFECT 02/01/2011
TX
Enumeration date
02/16/2010
Last updated
01/15/2020
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