Provider Demographics
NPI:1215289947
Name:ELSBERND, ELISE MARIE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ELISE
Middle Name:MARIE
Last Name:ELSBERND
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 1:2334 LAKE PARK RD
Mailing Address - Street 2:APT 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6606
Mailing Address - Country:US
Mailing Address - Phone:563-379-7134
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KENTUCKY CHILDRENS HOSPITAL
Practice Address - Street 2:800 ROSE STREET
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYIN PROCESS363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant