Individual
MRS. LARRIETTA LEANN ELLIOTTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 TRILLIUM WAY, CORBIN, KY 40701
(606) 526-4449
Mailing address
1 TRILLIUM WAY, CORBIN, KY 40701-8727
(606) 526-4449
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2027
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100379340
—
KY
01
—
P01520253
RR MEDICARE
KY
Enumeration date
08/17/2015
Last updated
12/04/2020
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