=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356390934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISABETH LANDRY KRYWAY PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7555 NORTHSIDE DR
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29420-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-797-8162
-----------------------------------------------------
Fax | 843-797-8372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7555 NORTHSIDE DR
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29420-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-797-8162
-----------------------------------------------------
Fax | 843-797-8372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA950
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 001000084
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------