Healthcare Provider Details

I. General information

NPI: 1861210387
Provider Name (Legal Business Name): ROCKI LYNN ELAM NP, CNS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FETCHET AVE
JB ANDREWS MD
20762-5157
US

IV. Provider business mailing address

10503 WILLIAMSVILLE RD
HANOVER VA
23069-1835
US

V. Phone/Fax

Practice location:
  • Phone: 804-690-9033
  • Fax:
Mailing address:
  • Phone: 804-690-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024181833
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0024181833
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number0024181833
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001205025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: