Provider Demographics
NPI:1174867451
Name:ELAM, KRISTIN COATES (RD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:COATES
Last Name:ELAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 PENNIMAN TER
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3050
Mailing Address - Country:US
Mailing Address - Phone:804-665-7800
Mailing Address - Fax:804-800-2470
Practice Address - Street 1:2308 PENNIMAN TER
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3050
Practice Address - Country:US
Practice Address - Phone:804-665-7800
Practice Address - Fax:804-800-2470
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA893234133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered