Provider Demographics
NPI:1538903380
Name:DR. KRISTI M. ELIA
Entity type:Organization
Organization Name:DR. KRISTI M. ELIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-864-8900
Mailing Address - Street 1:225 N NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5421
Mailing Address - Country:US
Mailing Address - Phone:870-864-8900
Mailing Address - Fax:870-864-8903
Practice Address - Street 1:225 N NEWTON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5421
Practice Address - Country:US
Practice Address - Phone:870-864-8900
Practice Address - Fax:870-864-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental