Healthcare Provider Details

I. General information

NPI: 1861988537
Provider Name (Legal Business Name): GAYLE ELLIOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N/A N/A NP

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GRIFFITH ST
PINEVILLE LA
71360-5270
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 401
TEXARKANA TX
75503-5211
US

V. Phone/Fax

Practice location:
  • Phone: 318-528-5000
  • Fax: 318-448-8013
Mailing address:
  • Phone: 903-614-5367
  • Fax: 903-614-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10054
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: