Healthcare Provider Details

I. General information

NPI: 1497663504
Provider Name (Legal Business Name): ASHLEY R ELDER AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 W PALMETTO ST STE D
FLORENCE SC
29501-4425
US

IV. Provider business mailing address

201 BEULAH CIR
CONWAY SC
29527-3791
US

V. Phone/Fax

Practice location:
  • Phone: 843-799-0083
  • Fax:
Mailing address:
  • Phone: 843-283-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number32489
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number32489
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number32489
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: