Healthcare Provider Details

I. General information

NPI: 1760258305
Provider Name (Legal Business Name): BRYANNA ELKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 CLEVELAND AVE
ASHLAND OH
44805-2714
US

IV. Provider business mailing address

1115 CLEVELAND AVE
ASHLAND OH
44805-2714
US

V. Phone/Fax

Practice location:
  • Phone: 330-601-6282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: