Provider Demographics
NPI:1104435163
Name:VERDEYEN, ELYSE (PA-C)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:VERDEYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BUSINESS PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7449
Mailing Address - Country:US
Mailing Address - Phone:417-336-0033
Mailing Address - Fax:855-710-6552
Practice Address - Street 1:110 BUSINESS PARK DR STE C
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7449
Practice Address - Country:US
Practice Address - Phone:417-336-0033
Practice Address - Fax:855-710-6552
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024022556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant