=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972516524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL MCCLURE ELLIOTT ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 03/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221B PROFESSIONAL CIR
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-247-2101
-----------------------------------------------------
Fax | 245-247-9469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 BLUE RIDGE RD SUITE 118
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27612-8086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-571-4399
-----------------------------------------------------
Fax | 919-571-7627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 900447
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------