Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R848503 | MS |
NPI | 1023109089 |
---|---|
Provider Name | Kathryn B Elliott |
First Address | Oxford, MS 38655-7900 |
Second Address | Oxford, MS 38655-7900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123149 | (05) | MS |
P16680 | (02) | MS |