Provider Demographics
NPI:1386888683
Name:ELLIOTT, LYDIA (FNP)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:ELLIOTT
Other - Last Name:LUKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:711 NEW LEICESTER HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 NEW LEICESTER HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1048
Practice Address - Country:US
Practice Address - Phone:828-253-3717
Practice Address - Fax:828-683-9615
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP87159Medicare UPIN