Healthcare Provider Details

I. General information

NPI: 1760360887
Provider Name (Legal Business Name): JESSICA LYNDALL ELLIOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 STATE FARM RD
BOONE NC
28607-4948
US

IV. Provider business mailing address

965 STATE FARM RD
BOONE NC
28607-4948
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-0029
  • Fax:
Mailing address:
  • Phone: 828-264-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5022931
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: