Provider Demographics
NPI:1639583222
Name:ELLIOTT, ALEASHA (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:ALEASHA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 MANGO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-0195
Mailing Address - Country:US
Mailing Address - Phone:573-560-8046
Mailing Address - Fax:636-266-8286
Practice Address - Street 1:111 CHURCH ST STE 10
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2894
Practice Address - Country:US
Practice Address - Phone:636-486-6770
Practice Address - Fax:866-783-4604
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014017980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily