Provider Demographics
NPI:1962099440
Name:ELAM, YOLANDA LYNETTE (NP)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:LYNETTE
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 1:167 MOSSY OAK CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3094
Mailing Address - Country:US
Mailing Address - Phone:803-603-9341
Mailing Address - Fax:
Practice Address - Street 1:167 MOSSY OAK CIR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3094
Practice Address - Country:US
Practice Address - Phone:803-603-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily