Healthcare Provider Details

I. General information

NPI: 1306434113
Provider Name (Legal Business Name): TREVA ELLIOTT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TREVA FLANNERY

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

PO BOX 151
ASHLAND KY
41105-0151
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-4000
  • Fax:
Mailing address:
  • Phone: 606-408-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015619
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: