Provider Demographics
NPI:1245579903
Name:DEHART, ELSA ARP (ANP)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:ARP
Last Name:DEHART
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MISSION RD STE 207
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7327
Mailing Address - Country:US
Mailing Address - Phone:907-539-1749
Mailing Address - Fax:
Practice Address - Street 1:316 MISSION RD STE 207
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7327
Practice Address - Country:US
Practice Address - Phone:907-539-1749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily