Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99042 | TX |
NPI | 1114106531 |
---|---|
Provider Name | Kristen Elliott |
First Address | Kyle, TX 78640-4640 |
Second Address | Kyle, TX 78640-4640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2007 |
Last Update Date | 01/11/2007 |