Provider Demographics
NPI:1225851256
Name:WOOTEN, ELAINA (APRN)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:WOOTEN
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 1:6071 E WOODMEN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2609
Mailing Address - Country:US
Mailing Address - Phone:719-212-4401
Mailing Address - Fax:
Practice Address - Street 1:6071 E WOODMEN RD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2609
Practice Address - Country:US
Practice Address - Phone:719-212-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0102846-C-NP363LP0808X
VA0001287754363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health