Healthcare Provider Details

I. General information

NPI: 1700401163
Provider Name (Legal Business Name): CAROLINE ETOK ELAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 E MARY ST
GARDEN CITY KS
67846-3617
US

IV. Provider business mailing address

2051 E MARY ST
GARDEN CITY KS
67846-3617
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-3777
  • Fax: 620-275-3074
Mailing address:
  • Phone: 620-275-3777
  • Fax: 620-275-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79421
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5379421111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: