Provider Demographics
NPI:1477040012
Name:ELKER, KEVIN DEAN (APRN, CNS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DEAN
Last Name:ELKER
Suffix:
Gender:M
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4754
Mailing Address - Country:US
Mailing Address - Phone:507-287-0674
Mailing Address - Fax:
Practice Address - Street 1:2110 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4754
Practice Address - Country:US
Practice Address - Phone:507-287-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0094364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health