Healthcare Provider Details

I. General information

NPI: 1871915389
Provider Name (Legal Business Name): KIRK E. ELLIOTT M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 OLIVE ST
ARNAUDVILLE LA
70512-6154
US

IV. Provider business mailing address

PO BOX 187
ARNAUDVILLE LA
70512-0187
US

V. Phone/Fax

Practice location:
  • Phone: 337-754-7254
  • Fax: 337-754-8047
Mailing address:
  • Phone: 337-754-7254
  • Fax: 337-754-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: KIRK E ELLIOTT
Title or Position: SOLE MEMBER
Credential: MD
Phone: 337-754-7254