Healthcare Provider Details

I. General information

NPI: 1972407716
Provider Name (Legal Business Name): KRISTIN C ELAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 TROON DR
SALISBURY NC
28144-8902
US

IV. Provider business mailing address

1511 TROON DR
SALISBURY NC
28144-8902
US

V. Phone/Fax

Practice location:
  • Phone: 804-665-7800
  • Fax:
Mailing address:
  • Phone: 804-665-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTIN COATES WHITFIELD
Title or Position: REGISTERED DIETITIAN
Credential: RD
Phone: 804-665-7800