Provider Demographics
NPI:1508320706
Name:MCELVAIN, KERSTIN ANNETTE (CRNP)
Entity type:Individual
Prefix:
First Name:KERSTIN
Middle Name:ANNETTE
Last Name:MCELVAIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E WAGON WHEEL LN STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6698
Mailing Address - Country:US
Mailing Address - Phone:928-788-3333
Mailing Address - Fax:928-788-3555
Practice Address - Street 1:3442 US HWY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950
Practice Address - Country:US
Practice Address - Phone:256-580-7660
Practice Address - Fax:256-580-7670
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ220904363LF0000X, 363L00000X
FL11006756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ499018Medicaid
14375499OtherCAQH