Provider Demographics
NPI:1154097152
Name:ELKIN, ERICA CHANCEY (FNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:CHANCEY
Last Name:ELKIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 BLUECUTT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1303
Mailing Address - Country:US
Mailing Address - Phone:662-570-4770
Mailing Address - Fax:662-570-4724
Practice Address - Street 1:56 DUTCH LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5500
Practice Address - Country:US
Practice Address - Phone:662-329-3808
Practice Address - Fax:662-329-3873
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903867363LF0000X
MSELKI-14F9XY363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily