=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619426400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERITH CHRISTINA ELROD DNP, CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2016
-----------------------------------------------------
Last Update Date | 02/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2420 S CROATAN HWY STE D
-----------------------------------------------------
City | NAGS HEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27959-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-715-1129
-----------------------------------------------------
Fax | 252-719-1128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2420 S CROATAN HWY STE D
-----------------------------------------------------
City | NAGS HEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27959-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-715-1129
-----------------------------------------------------
Fax | 252-719-1128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 5016906
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------