Provider Demographics
NPI:1184101883
Name:ELMORE, AMBER (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1295 PASSAGE DR
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-6905
Mailing Address - Country:US
Mailing Address - Phone:928-368-7346
Mailing Address - Fax:928-495-5514
Practice Address - Street 1:4672 MAVERICK LN STE 1
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5459
Practice Address - Country:US
Practice Address - Phone:928-368-7346
Practice Address - Fax:928-495-5514
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71525207LA0401X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100961100Medicaid
FLKH438OtherMEDICARE