Provider Demographics
NPI:1962720458
Name:ELDER, PAULA C (ACNP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:C
Last Name:ELDER
Suffix:
Gender:
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8512
Mailing Address - Country:US
Mailing Address - Phone:314-448-3791
Mailing Address - Fax:314-996-7658
Practice Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8512
Practice Address - Country:US
Practice Address - Phone:618-463-8500
Practice Address - Fax:314-747-4153
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010014014363L00000X, 363LA2100X
IL209021932363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1962720458Medicaid
MO137740016Medicare PIN
MOP01032132Medicare PIN
MO1962720458Medicaid