Provider Demographics
NPI:1427443530
Name:LOOMIS, ELENA (NP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51733
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1733
Mailing Address - Country:US
Mailing Address - Phone:806-352-9090
Mailing Address - Fax:806-340-7961
Practice Address - Street 1:6111 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1901
Practice Address - Country:US
Practice Address - Phone:806-352-9090
Practice Address - Fax:806-340-7961
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127808363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200589480 AMedicaid
TX348597101Medicaid
NM05334004Medicaid
TX348597102Medicaid
TX348597102Medicaid