MEDICARE: VERNITA ANN ELLIOTT EDD

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	305R00000X	Preferred Provider Organization
2	1041S0200X	School Social Worker	PPS-559558	VA

General Provider Information

NPI Number	:	1700623873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNITA ANN ELLIOTT EDD

Provider Business Mailing Address
First Line	:	207 W 2ND AVE
Second Line	:
City	:	FRANKLIN
State	:	VA
Zip	:	23851-1713
Country	:	US
Telephone Number	:	757-569-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 W 2ND AVE
Second Line	:
City	:	FRANKLIN
State	:	VA
Zip	:	23851-1713
Country	:	US
Telephone Number	:	757-569-8111
Fax Number	:

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

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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Directions to “ VERNITA ANN ELLIOTT EDD” Practice Location

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