# JERRY G ELLIOTT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1114152758
- **Gender:** Man
- **Credential:** NP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | AP60240764 | WA | Yes |
| 363L00000X | Nurse Practitioner | N-35393 | ID | — |
| 363L00000X | Nurse Practitioner | NP-917A | ID | — |

## Other

- **Enumeration date:** 05/27/2009
- **Last updated:** 11/08/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002803300 | — | ID |