Provider Demographics
NPI:1942819974
Name:ELLIOTT, NICHOLAS HEITH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:HEITH
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 BARNES CROSSING ROAD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-0909
Mailing Address - Country:US
Mailing Address - Phone:662-841-0002
Mailing Address - Fax:662-269-6346
Practice Address - Street 1:874 BARNES CROSSING ROAD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0909
Practice Address - Country:US
Practice Address - Phone:662-841-0002
Practice Address - Fax:662-269-6346
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty