Individual
ELYSSEE FREJOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
(254) 724-7603
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
AP140133
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
403558601
—
TX
01
—
403558602
CSHCN MEDICAID
TX
01
—
8LT457
BCBS
TX
Enumeration date
06/03/2016
Last updated
05/10/2021
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