Healthcare Provider Details

I. General information

NPI: 1760735294
Provider Name (Legal Business Name): KATIE ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 HIGHWAY 65 S
DUMAS AR
71639-3004
US

IV. Provider business mailing address

790 ROBERTS DR
MONTICELLO AR
71655-5723
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-2461
  • Fax: 870-460-6133
Mailing address:
  • Phone: 870-367-2461
  • Fax: 870-460-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: