Provider Demographics
NPI:1831194984
Name:ELLIOTT, RHONDA SMITH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:SMITH
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 JAKE ALEXANDER BLVD W STE 104
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1385
Practice Address - Country:US
Practice Address - Phone:701-645-0901
Practice Address - Fax:704-645-0907
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P49956Medicare UPIN
NC2754491Medicare ID - Type Unspecified