Provider Demographics
NPI:1295705762
Name:ELLIOTT, NANCY HELMICK (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:HELMICK
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 VAN VOORHIS RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3478
Mailing Address - Country:US
Mailing Address - Phone:304-599-9400
Mailing Address - Fax:304-599-8917
Practice Address - Street 1:1197 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3478
Practice Address - Country:US
Practice Address - Phone:304-599-9400
Practice Address - Fax:304-599-8917
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV970024932OtherMEDICARE/RAILROAD
WV970024932OtherMEDICARE/RAILROAD