Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP111626 | TX |
NPI | 1043318314 |
---|---|
Provider Name | Mrs. Roxanne Elkins Timm |
First Address | San Angelo, TX 76902-7200 |
Second Address | San Angelo, TX 76903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 26/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04298136 | NCC (01) | TX |
155067502 | (05) | TX |
385696YKRY | MEDICARE (01) | TX |