Provider Demographics
NPI:1346979358
Name:OKESON, ELISSA MAY (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:MAY
Last Name:OKESON
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11271 CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3106
Mailing Address - Country:US
Mailing Address - Phone:720-326-3451
Mailing Address - Fax:
Practice Address - Street 1:11271 CLARKSON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-3106
Practice Address - Country:US
Practice Address - Phone:720-326-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997560-NP363LA2100X
COANP.0997560-NP364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0997560-NPMedicaid