Healthcare Provider Details

I. General information

NPI: 1174489348
Provider Name (Legal Business Name): KELLIE ERIN PIKE-DELAMERENS RDN LDN MSCHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CAMINHA RD
ST AUGUSTINE FL
32084-0056
US

IV. Provider business mailing address

101 CAMINHA RD
ST AUGUSTINE FL
32084-0056
US

V. Phone/Fax

Practice location:
  • Phone: 904-295-5545
  • Fax:
Mailing address:
  • Phone: 904-295-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberND8167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: