Healthcare Provider Details

I. General information

NPI: 1699333021
Provider Name (Legal Business Name): STEPHANIE CARLILE ELAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 WENDOVER HEIGHTS DR
SHELBY NC
28150-3565
US

IV. Provider business mailing address

PO BOX 470408
CHARLOTTE NC
28247-0408
US

V. Phone/Fax

Practice location:
  • Phone: 704-487-4677
  • Fax:
Mailing address:
  • Phone: 704-487-4677
  • Fax: 704-887-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011828
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: