Provider Demographics
NPI:1649935503
Name:ELLIOTT, KATIE THERESA (FNP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:THERESA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:THERESA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1407 BLOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1888
Mailing Address - Country:US
Mailing Address - Phone:256-302-3876
Mailing Address - Fax:
Practice Address - Street 1:1407 BLOUNT AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1888
Practice Address - Country:US
Practice Address - Phone:833-582-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182724363LF0000X
AL1-194290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily