Philip Resin Elackatt, RN

Primary specialty

Pain Management Registered NurseTaxonomy code 163WP0000X

License

900887 Issued in TX

Practice address

500 W Fort St
Boise, ID 83702-4501

Phone

(986) 256-1766

NPI assigned

Jul 1, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1013753946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3307 IVY MILL LN",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774596525",
            "telephone_number": "630-765-4384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W FORT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024501",
            "telephone_number": "986-256-1766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELACKATT",
        "first_name": "PHILIP",
        "middle_name": "RESIN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pain Management",
            "state": "TX",
            "license": "900887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Leigh Eisele, PSY.D.
• Kelly Eisenbarger, MSW
• Michael John Eisenbeiss Sr., PSYCHOLOGIST COUNSEL
• Amanda P Eisenberg, LPC, LAMFT
• Mary-Katherine Ekins, MS, LPC
• Elaine Key MD PLLC
• Ahmed Elbermawy, MD
• Jacquie Anne Elcox, BC- HIS
• Khaled Eldemerdash, RPH
• Becky M. Elder, NP

• All providers in Boise, ID
• Pain Management Registered Nurse in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.