Provider Demographics
NPI:1174033146
Name:ELROD, KAITLYN GERALDINE (PA-C ATC)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:GERALDINE
Last Name:ELROD
Suffix:
Gender:F
Credentials:PA-C ATC
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:GERALDINE
Other - Last Name:MULDOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, ATC
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 VAIL AVENUE
Practice Address - Street 2:MSKI THIRD FLOOR, SUITE 3042
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-304-5876
Practice Address - Fax:704-446-8870
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08384363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3473PAMedicaid