Provider Demographics
NPI:1023109089
Name:ELLIOTT, KATHRYN B (WHNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:B
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7900
Mailing Address - Country:US
Mailing Address - Phone:662-234-0332
Mailing Address - Fax:662-234-2891
Practice Address - Street 1:551 AZALEA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7900
Practice Address - Country:US
Practice Address - Phone:662-234-0332
Practice Address - Fax:662-234-2891
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR848503363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS123149Medicaid
MS50000113Medicare ID - Type UnspecifiedMEDICARE
MS123149Medicaid