Basic Information
Provider Information | |||||||||
NPI: | 1417002486 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUSSEY | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | LEACHMAN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RNC, NNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1869 | ||||||||
Address2: |   | ||||||||
City: | FLETCHER | ||||||||
State: | NC | ||||||||
PostalCode: | 287321869 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286875616 | ||||||||
FaxNumber: | 8286508076 | ||||||||
Practice Location | |||||||||
Address1: | 100 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 287925272 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286812294 | ||||||||
FaxNumber: | 8286812749 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/23/2007 | ||||||||
LastUpdateDate: | 10/13/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 169280 | NC | N |   | Nursing Service Providers | Registered Nurse |   | 363LN0005X | 9401361 | NC | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care | 363LN0000X | 15561 | TN | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | 363LN0000X | 169280 | NC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
ID Information
ID | Type | State | Issuer | Description | P01685737 | 01 | NC | MEDICARE RAIL ROAD | OTHER |