Provider Demographics
NPI:1124419981
Name:ELLIOTT, JOANNA (APRN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3064
Mailing Address - Country:US
Mailing Address - Phone:580-254-8192
Mailing Address - Fax:
Practice Address - Street 1:1611 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3064
Practice Address - Country:US
Practice Address - Phone:580-254-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0088924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200574930AMedicaid