Healthcare Provider Details

I. General information

NPI: 1447792981
Provider Name (Legal Business Name): ELIZABETH ASHLEY MARTIN BHATTA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 01/24/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402
APO AE
09180
US

IV. Provider business mailing address

CMR 402 BOX 1261
APO AE
09180-0013
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-4024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number85070
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN 2223
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN 2223
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: