Provider Demographics
NPI:1700465895
Name:PATTILLO, ELYSSA MULHERON (MHS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:MULHERON
Last Name:PATTILLO
Suffix:
Gender:F
Credentials:MHS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 PINE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-7941
Mailing Address - Country:US
Mailing Address - Phone:866-772-0267
Mailing Address - Fax:
Practice Address - Street 1:925 PINE SHORE DR
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-7941
Practice Address - Country:US
Practice Address - Phone:828-774-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86065017133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered