Provider Demographics
NPI:1235949439
Name:ELLIOTT, LEXIS LAMB (FNP)
Entity type:Individual
Prefix:
First Name:LEXIS
Middle Name:LAMB
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 BEACON ST NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5348
Mailing Address - Country:US
Mailing Address - Phone:704-280-0254
Mailing Address - Fax:
Practice Address - Street 1:1096 ASSEMBLY DR STE 210
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6448
Practice Address - Country:US
Practice Address - Phone:704-368-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily