=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174489348
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLIE ERIN PIKE-DELAMERENS RDN LDN MSCHN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 CAMINHA RD
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32084-0056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-295-5545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 CAMINHA RD
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32084-0056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-295-5545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number | ND8167
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------