Provider Demographics
NPI:1306434113
Name:ELLIOTT, TREVA (APRN)
Entity type:Individual
Prefix:
First Name:TREVA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TREVA
Other - Middle Name:
Other - Last Name:FLANNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-8944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 MCDAVID BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1603
Practice Address - Country:US
Practice Address - Phone:606-474-7835
Practice Address - Fax:606-474-8114
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily