Provider Demographics
NPI:1073581674
Name:ELLIOT, KATHERINE COLLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:COLLEEN
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N CLEVELAND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8388
Mailing Address - Country:US
Mailing Address - Phone:614-818-0300
Mailing Address - Fax:614-818-0313
Practice Address - Street 1:444 N CLEVELAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8388
Practice Address - Country:US
Practice Address - Phone:614-818-0300
Practice Address - Fax:614-818-0313
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN286863363LP2300X
OHAPRN.CNP.08707363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630040Medicaid
OHQ61773Medicare UPIN