Healthcare Provider Details

I. General information

NPI: 1942819974
Provider Name (Legal Business Name): NICHOLAS HEITH ELLIOTT DNP, FNP-BC, PMHNP-B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COUNTY ROAD 3150
BOONEVILLE MS
38829-8859
US

IV. Provider business mailing address

1937 BRIAR RIDGE RD
TUPELO MS
38804-5963
US

V. Phone/Fax

Practice location:
  • Phone: 501-517-9233
  • Fax:
Mailing address:
  • Phone: 662-690-4200
  • Fax: 662-690-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number904025
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904025
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: