Provider Demographics
NPI:1003233479
Name:ELLIOTT, HEATHER A (MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:LYSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1014 ELM AVE
Mailing Address - Street 2:P.O. BOX 590
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-1328
Mailing Address - Country:US
Mailing Address - Phone:719-254-7421
Mailing Address - Fax:719-254-6966
Practice Address - Street 1:1014 ELM AVE
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-1328
Practice Address - Country:US
Practice Address - Phone:719-254-7421
Practice Address - Fax:719-254-6966
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991105-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily