Provider Demographics
NPI:1609810282
Name:MCELHANON, JOBETH ROSS (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JOBETH
Middle Name:ROSS
Last Name:MCELHANON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4217
Mailing Address - Country:US
Mailing Address - Phone:501-202-2117
Mailing Address - Fax:501-202-7191
Practice Address - Street 1:9601 INTERSTATE EXIT 7
Practice Address - Street 2:BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7299
Practice Address - Country:US
Practice Address - Phone:501-202-2117
Practice Address - Fax:501-202-7191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR642133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X042OtherMNT PROVIDER