Provider Demographics
NPI:1568572279
Name:WARDEN, ELYSHIA MICHELLE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ELYSHIA
Middle Name:MICHELLE
Last Name:WARDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 MENDENHALL OAKS PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8076
Mailing Address - Country:US
Mailing Address - Phone:336-887-3195
Mailing Address - Fax:336-887-3194
Practice Address - Street 1:4010 MENDENHALL OAKS PKWY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8076
Practice Address - Country:US
Practice Address - Phone:336-887-3195
Practice Address - Fax:336-887-3194
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00542363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-00542OtherNC MEDICAL BOARD