Provider Demographics
NPI:1699333021
Name:ELAM, STEPHANIE CARLILE (NP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CARLILE
Last Name:ELAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4707
Mailing Address - Country:US
Mailing Address - Phone:704-477-4329
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA CARE HEALTH AND REHAB
Practice Address - Street 2:111 HARRILSON ROAD
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021
Practice Address - Country:US
Practice Address - Phone:704-435-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR0400X
NC5011828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation