Most Relevant Information
Provider Data
| NPI Number: | 1003457862 |
| Provider Name: | AMIEE DARLENE BURKS ELAM |
| Entity Type: | Individual |
| Taxonomy Code: | 164X00000X |
| Specialty: | Licensed Vocational Nurse |
| License Number: | 192528 |
Most Important Dates
| Enumeration Date: | 10/03/2019 |
| Last Updated: | 10/03/2019 |
Provider Practice Location
120 N WALNUT ST
JEFFERSON
TX
756571934
Practice Location Phone/Fax
| Phone: | 9036656131 |
| Fax: |
Provider Mailing Location
PO BOX 901
JEFFERSON
TX
756570901
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |