1548631401 NPI number — MRS. KELLY MICHELLE MCELROY MS, RDN, LDN

Table of content: MRS. KELLY MICHELLE MCELROY MS, RDN, LDN (NPI 1548631401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548631401 NPI number — MRS. KELLY MICHELLE MCELROY MS, RDN, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCELROY
Provider First Name:
KELLY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIETROSANTI
Provider Other First Name:
KELLY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548631401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5741 ARROWHEAD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT BENNING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31905-1951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5741 ARROWHEAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-727-9458
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LD004266 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133V00000X , with the licence number: 974658 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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