Provider Demographics
NPI:1639912157
Name:ELLIOTT, EMILY GRACE (MSN RN AGACNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:ELLIOTT
Suffix:
Gender:
Credentials:MSN RN AGACNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:GRACE
Other - Last Name:COATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:3024 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1247
Practice Address - Country:US
Practice Address - Phone:919-350-7331
Practice Address - Fax:919-350-6999
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311136163W00000X
NC5020376363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639912157Medicaid