Provider Demographics
NPI:1316539729
Name:VERNON, ELIJAH S (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:S
Last Name:VERNON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 DOWNEY PL
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3905
Mailing Address - Country:US
Mailing Address - Phone:704-689-6944
Mailing Address - Fax:
Practice Address - Street 1:612 DOWNEY PL
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3905
Practice Address - Country:US
Practice Address - Phone:704-689-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily