Healthcare Provider Details

I. General information

NPI: 1164925699
Provider Name (Legal Business Name): ELYSIA PLYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 INDIA HOOK RD STE AND105
ROCK HILL SC
29732-3530
US

IV. Provider business mailing address

181 W PROFESSIONAL PARK CT STE 1
BOWLING GREEN KY
42104-3250
US

V. Phone/Fax

Practice location:
  • Phone: 803-366-6250
  • Fax:
Mailing address:
  • Phone: 270-777-9283
  • Fax: 270-777-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-43005
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: