Provider Demographics
NPI:1972516524
Name:ELLIOTT, CHERYL MCCLURE (ANP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MCCLURE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8086
Mailing Address - Country:US
Mailing Address - Phone:919-571-4399
Mailing Address - Fax:919-571-7627
Practice Address - Street 1:221B PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4303
Practice Address - Country:US
Practice Address - Phone:252-247-2101
Practice Address - Fax:245-247-9469
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900447363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003525Medicaid
NCNCM111AMedicare PIN
NCQ43455Medicare UPIN