Basic Information
| Provider Information | |||||||||
| NPI: | 1053663716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELROD | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152841400 | ||||||||
| FaxNumber: | 6152844970 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 20TH AVE N | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152841400 | ||||||||
| FaxNumber: | 6152844970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2226 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P01237521 | 01 | TN | RR MEDICARE | OTHER | 6001536 | 01 | TN | BCBS | OTHER | Q001813 | 05 | TN | MEDICAID |