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General NPI Number Information
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NPI Number | 1538752084
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Entity Type | Organization
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Legal Business Name | ELITE HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 428 COURTHOUSE RD STE B
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City | GULFPORT
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State | MS
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Zip | 39507-1868
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Country | US
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Telephone | 228-207-0408
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Fax | 228-207-0409
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Provider Business Mailing Address
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Address Line | 428 COURTHOUSE RD STE B
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City | GULFPORT
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State | MS
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Zip | 39507-1868
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Country | US
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Telephone | 228-207-0408
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Fax | 228-207-0409
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Authorized Official
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Title or Position | NP/OWNER
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Name | MS. CRYSTAL D. HEATHINGTON
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Credential | APRN, NP-C
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Telephone | 228-207-0408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SW0102X
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Taxonomy Name | Women's Health Clinical Nurse Specialist
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License Number |
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License Number State |
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