Individual
MS. ELISA BENNETT MAULDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
17 SHADOWRIDGE DR APT 1, WILLIAMSBURG, KY 40769-2111
(864) 325-6982
Mailing address
17 SHADOWRIDGE DR APT 1, WILLIAMSBURG, KY 40769-2111
(864) 325-6982
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/16/2023
Last updated
10/17/2023
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