Basic Information
| Provider Information | |||||||||
| NPI: | 1881882876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCELVEEN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | MCKNIGHT | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCKNIGHT | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 578 | ||||||||
| Address2: | |||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291020578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034336790 | ||||||||
| FaxNumber: | 8034336796 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 THURGOOD MARSHALL HWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | KINGSTREE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295564108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433555628 | ||||||||
| FaxNumber: | 8433556072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 07/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1241 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.