Healthcare Provider Details

I. General information

NPI: 1669827978
Provider Name (Legal Business Name): MS. ELANA J RATLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S MAIN ST
KERNERSVILLE NC
27284-7478
US

IV. Provider business mailing address

1101 S MAIN ST
KERNERSVILLE NC
27284-7478
US

V. Phone/Fax

Practice location:
  • Phone: 336-996-4021
  • Fax:
Mailing address:
  • Phone: 336-996-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number197605
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008569
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: