Provider Demographics
NPI:1881114635
Name:ELKINS, CARISSA M (MD)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:M
Last Name:ELKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:45334-6001
Mailing Address - Country:US
Mailing Address - Phone:937-596-0456
Mailing Address - Fax:937-596-0462
Practice Address - Street 1:805 E PIKE ST
Practice Address - Street 2:
Practice Address - City:JACKSON CENTER
Practice Address - State:OH
Practice Address - Zip Code:45334-6001
Practice Address - Country:US
Practice Address - Phone:937-596-0456
Practice Address - Fax:937-596-0462
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.140064207Q00000X
OHAPP-000359724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine