Healthcare Provider Details

I. General information

NPI: 1558288704
Provider Name (Legal Business Name): SARA ELLIOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COPPERFIELD BLVD NE STE 124
CONCORD NC
28025-2454
US

IV. Provider business mailing address

601 AVENIDA CESAR E CHAVEZ APT 117
KANSAS CITY MO
64108-2388
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-9267
  • Fax:
Mailing address:
  • Phone: 847-650-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5024793
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: