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General NPI Number Information
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NPI Number | 1265503130
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Entity Type | Individual
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Provider Name | ERIC ELLIOTT MSN-APRN
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2400 BOONSLICK DR
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City | BOONVILLE
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State | MO
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Zip | 65233-1935
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Country | US
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Telephone | 660-882-9840
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Fax | 660-882-3504
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Provider Business Mailing Address
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Address Line | PO BOX 5111
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City | SPRINGFIELD
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State | MO
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Zip | 65801-5111
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Country | US
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Telephone | 660-882-9840
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Fax | 660-882-3504
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2001021688
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License Number State | MO
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