Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 1-110201 | AL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R887805 | MS |
NPI | 1003122821 |
---|---|
Provider Name | John C Elkins |
First Address | Pascagoula, MS 39581-5509 |
Second Address | Pascagoula, MS 39581-5509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2010 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003122821 | TRICARE SOUTH (01) | AL |
122801 | (05) | AL |
122803 | (05) | AL |
511-10258 | BCBS (01) | AL |
511-10260 | BCBS (01) | AL |
Z12065 | VIVA HEALTH (01) | AL |