Healthcare Provider Details

I. General information

NPI: 1942085915
Provider Name (Legal Business Name): LAUREN BOSTWICK MCELVEEN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 BOWMAN RD STE 104
MOUNT PLEASANT SC
29464-3235
US

IV. Provider business mailing address

913 BOWMAN RD STE 104
MT PLEASANT SC
29464-3235
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-7640
  • Fax: 843-216-2528
Mailing address:
  • Phone: 843-216-7640
  • Fax: 843-216-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1201326
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: