Healthcare Provider Details

I. General information

NPI: 1073581674
Provider Name (Legal Business Name): KATHERINE COLLEEN ELLIOT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N CLEVELAND AVE STE 120
WESTERVILLE OH
43082-8388
US

IV. Provider business mailing address

444 N CLEVELAND AVE STE 120
WESTERVILLE OH
43082-8388
US

V. Phone/Fax

Practice location:
  • Phone: 614-818-0300
  • Fax: 614-818-0313
Mailing address:
  • Phone: 614-818-0300
  • Fax: 614-818-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN286863
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.08707
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: