Provider Demographics
NPI:1881975654
Name:ELAM, LELIA (RD)
Entity type:Individual
Prefix:
First Name:LELIA
Middle Name:
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 1:626 DRY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-7592
Mailing Address - Country:US
Mailing Address - Phone:606-663-9011
Mailing Address - Fax:606-663-9012
Practice Address - Street 1:176 12TH ST
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:KY
Practice Address - Zip Code:40312-8981
Practice Address - Country:US
Practice Address - Phone:606-663-9011
Practice Address - Fax:606-663-9012
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered