Provider Demographics
NPI:1790757995
Name:MCELROY, GAYLE STACKHOUSE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:STACKHOUSE
Last Name:MCELROY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 STONINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5228
Mailing Address - Country:US
Mailing Address - Phone:336-765-2334
Mailing Address - Fax:
Practice Address - Street 1:1200 ML KING DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-713-9665
Practice Address - Fax:336-713-9655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101427363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2763457Medicare ID - Type Unspecified
NCQ43932Medicare UPIN