Provider Demographics
NPI:1073999363
Name:KRISTIN C ELAM LLC
Entity Type:Organization
Organization Name:KRISTIN C ELAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:804-665-7800
Mailing Address - Street 1:8219 OVERBURY RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1645
Mailing Address - Country:US
Mailing Address - Phone:804-665-7800
Mailing Address - Fax:804-515-0097
Practice Address - Street 1:8219 OVERBURY RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1645
Practice Address - Country:US
Practice Address - Phone:804-665-7800
Practice Address - Fax:804-515-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty