MEDICARE: LISA B ELGIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R826442	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083655724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA B ELGIN NP

Provider Business Mailing Address
First Line	:	PO BOX 1100
Second Line	:
City	:	MAGEE
State	:	MS
Zip	:	39111-1100
Country	:	US
Telephone Number	:	662-369-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 S CHESTNUT ST
Second Line	:
City	:	ABERDEEN
State	:	MS
Zip	:	39730-3334
Country	:	US
Telephone Number	:	662-369-9500
Fax Number	:	662-369-0260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	04/09/2025

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Directions to “ LISA B ELGIN NP” Practice Location

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