Provider Demographics
NPI:1588293344
Name:ELLIOTT, JOCELYN GRAY (MD)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:GRAY
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOCELYN
Other - Middle Name:ANNE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1225 E CENTERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-1225
Mailing Address - Country:US
Mailing Address - Phone:479-795-1301
Mailing Address - Fax:
Practice Address - Street 1:1225 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-1225
Practice Address - Country:US
Practice Address - Phone:479-795-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36104207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine