Provider Demographics
NPI:1881873909
Name:KIRKPATRICK, ELIZABETH DETRICK (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DETRICK
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BEACONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1170
Mailing Address - Country:US
Mailing Address - Phone:336-337-7484
Mailing Address - Fax:
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:SUITE 108
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-337-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002735133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered