Provider Demographics
NPI:1548631401
Name:MCELROY, KELLY MICHELLE (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELLE
Last Name:MCELROY
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MICHELLE
Other - Last Name:PIETROSANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:5741 ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-1951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5741 ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-1951
Practice Address - Country:US
Practice Address - Phone:210-727-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004266133V00000X
974658133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered