MEDICARE: MRS. KATIE THERESA ELLIOTT FNP

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	0024182724	VA
2	363LF0000X	Family Nurse Practitioner	1-194290	AL

General Provider Information

NPI Number	:	1649935503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE THERESA ELLIOTT FNP

Provider Business Mailing Address
First Line	:	1407 BLOUNT AVE
Second Line	:
City	:	GUNTERSVILLE
State	:	AL
Zip	:	35976-1888
Country	:	US
Telephone Number	:	256-302-3876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 BLOUNT AVE
Second Line	:
City	:	GUNTERSVILLE
State	:	AL
Zip	:	35976-1888
Country	:	US
Telephone Number	:	833-582-2324
Fax Number	:

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

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	10/05/2023

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