Provider Demographics
NPI:1073915880
Name:BEDINGFIELD, ELENA KAY (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:KAY
Last Name:BEDINGFIELD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5109
Mailing Address - Country:US
Mailing Address - Phone:336-721-0606
Mailing Address - Fax:
Practice Address - Street 1:639 S GREEN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5109
Practice Address - Country:US
Practice Address - Phone:336-721-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007135363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health