=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235733155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2020
-----------------------------------------------------
Last Update Date | 03/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4555 35TH AVE
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39305-2544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-207-2017
-----------------------------------------------------
Fax | 601-207-1227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4820 POPLAR SPRINGS DR. STE. A, PMB 191
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39305-2678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-207-2017
-----------------------------------------------------
Fax | 601-207-1227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | LUCY BARNES
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 601-207-2017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------