Individual
JERRY G ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
888 SWIFT BLVD, RICHLAND, WA 99352
(509) 946-9611
(509) 942-2185
Mailing address
560 GAGE BLVD, SUITE 203, RICHLAND, WA 99352
(509) 942-3627
(509) 942-2268
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP60240764
WA
363L00000X
Nurse Practitioner
N-35393
ID
363L00000X
Nurse Practitioner
NP-917A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002803300
—
ID
Enumeration date
05/27/2009
Last updated
11/08/2016
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