Healthcare Provider Details

I. General information

NPI: 1497185011
Provider Name (Legal Business Name): ELSPETH GUNNOE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 KENNEDY ST NE
ROANOKE VA
24012-3601
US

IV. Provider business mailing address

3023 KENNEDY ST NE
ROANOKE VA
24012-3601
US

V. Phone/Fax

Practice location:
  • Phone: 540-524-2940
  • Fax:
Mailing address:
  • Phone: 540-524-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP251326
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024177647
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001287030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: