Provider Demographics
NPI:1770202004
Name:CALCOTE, ELISHA A (NP)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:A
Last Name:CALCOTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:A
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8333 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8083
Mailing Address - Country:US
Mailing Address - Phone:409-332-4300
Mailing Address - Fax:
Practice Address - Street 1:8333 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8083
Practice Address - Country:US
Practice Address - Phone:409-883-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090211363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health