Provider Demographics
NPI:1851912893
Name:BALL, ELISE MEYER (MS, RDN)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MEYER
Last Name:BALL
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12706 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8191
Mailing Address - Country:US
Mailing Address - Phone:502-727-8855
Mailing Address - Fax:
Practice Address - Street 1:680 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2407
Practice Address - Country:US
Practice Address - Phone:502-596-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY239671133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered