Healthcare Provider Details

I. General information

NPI: 1942942479
Provider Name (Legal Business Name): LAUREN ELISE MYERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAUREN ELISE SETZKORN

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVANIA DR
BEAVERCREEK OH
45440-3237
US

IV. Provider business mailing address

P.O. BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 937-320-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007494RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: