Provider Demographics
NPI:1902915127
Name:COONS, ELIZABETH LEE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LEE
Last Name:COONS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 IRON HORSE RD
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4319
Mailing Address - Country:US
Mailing Address - Phone:843-793-5970
Mailing Address - Fax:843-419-5391
Practice Address - Street 1:3495 IRON HORSE RD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4319
Practice Address - Country:US
Practice Address - Phone:843-793-5970
Practice Address - Fax:843-419-5391
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3011363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1024Medicaid
SCGP6738Medicaid
SCNP1024Medicaid
SCGP6738Medicaid