Provider Demographics
NPI:1528266459
Name:BYERLY, ELIZABETH A (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BYERLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BEFUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1595 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-212-8080
Practice Address - Fax:843-789-1521
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4223Medicaid
SCNP4223Medicaid
SCSC89497498Medicare PIN
OH3147419Medicaid
OH2396081OtherLODI COMMUITY HOSPITAL MEDICAID GROUP #
SCSC89497498Medicare PIN
OHNP23811Medicare PIN