# JACKLYN MARIE ELMER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1710209903
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA06585 | TX | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |

## Other

- **Enumeration date:** 02/16/2010
- **Last updated:** 01/15/2020

## 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 |