Provider Demographics
NPI:1396088530
Name:APPLEGATE, ELISE CHURCHILL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:CHURCHILL
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ELISE
Other - Middle Name:NANCY
Other - Last Name:CHURCHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY DR E
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2661
Practice Address - Country:US
Practice Address - Phone:979-691-3300
Practice Address - Fax:979-691-3527
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8173NNOtherBCBS
TX341236301Medicaid
TX8173NNOtherBCBS