Provider Demographics
NPI:1235900358
Name:ELROD, MISTY R (PSS)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:R
Last Name:ELROD
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3882 RIO VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7727
Mailing Address - Country:US
Mailing Address - Phone:541-891-9861
Mailing Address - Fax:
Practice Address - Street 1:3882 RIO VISTA WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7727
Practice Address - Country:US
Practice Address - Phone:541-891-9861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110298175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist