Healthcare Provider Details

I. General information

NPI: 1982198131
Provider Name (Legal Business Name): KARI L ELLIOTT DNP, CPNP-PC, AE-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N 14TH ST STE 207
PONCA CITY OK
74601-2039
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-9355
  • Fax: 580-765-0336
Mailing address:
  • Phone: 580-762-9355
  • Fax: 580-765-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number213340
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213340
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: