Healthcare Provider Details

I. General information

NPI: 1407477508
Provider Name (Legal Business Name): ELIZABETH GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 PRIVATE ROAD 1699
KNOXVILLE AR
72845-8578
US

IV. Provider business mailing address

592 PRIVATE ROAD 1699
KNOXVILLE AR
72845-8578
US

V. Phone/Fax

Practice location:
  • Phone: 479-214-1188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number126678
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: