Active NPI
Kellie Elkins
- Specialist
- Pinetop, AZ
National Provider Identifier
1124255815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 12498
- Practice address
- 3031 Buck Crossing Way
Pinetop, AZ 85935-8489 - Phone
- (928) 358-1570
- NPI assigned
- Jun 19, 2009
- Last updated
- Jun 19, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 12498 | AZ | Primary |
Addresses
Primary practice location
3031 Buck Crossing Way
Pinetop, AZ 85935-8489
Mailing address
3031 Buck Crossing Way
Pinetop, AZ 85935-8489
Phone (928) 205-1960
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12498 | AZ | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245369600000",
"number": "1124255815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3031 BUCK CROSSING WAY",
"city": "PINETOP",
"state": "AZ",
"postal_code": "859358489",
"telephone_number": "928-205-1960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3031 BUCK CROSSING WAY",
"city": "PINETOP",
"state": "AZ",
"postal_code": "859358489",
"telephone_number": "928-358-1570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELKINS",
"first_name": "KELLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-19",
"last_updated": "2009-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "12498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinetop, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.