Healthcare Provider Details

I. General information

NPI: 1811850845
Provider Name (Legal Business Name): CHARLES NATHAN MCELWRATH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 10457
CONWAY AR
72034-0006
US

IV. Provider business mailing address

PO BOX 10457
CONWAY AR
72034-0006
US

V. Phone/Fax

Practice location:
  • Phone: 501-697-9914
  • Fax:
Mailing address:
  • Phone: 501-697-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: