1174033146 NPI number — MRS. KAITLYN GERALDINE ELROD PA-C ATC

Table of content: MRS. KAITLYN GERALDINE ELROD PA-C ATC (NPI 1174033146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174033146 NPI number — MRS. KAITLYN GERALDINE ELROD PA-C ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELROD
Provider First Name:
KAITLYN
Provider Middle Name:
GERALDINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULDOON
Provider Other First Name:
KAITLYN
Provider Other Middle Name:
GERALDINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174033146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28219-9305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 VAIL AVENUE
Provider Second Line Business Practice Location Address:
MSKI THIRD FLOOR, SUITE 3042
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-304-5876
Provider Business Practice Location Address Fax Number:
704-446-8870
Provider Enumeration Date:
10/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  0010-08384 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 0010-08384 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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