Provider Demographics
NPI:1447540406
Name:MCKINLEY, ELIZABETH (RD, LD, NSCA-CPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:RD, LD, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2805
Mailing Address - Country:US
Mailing Address - Phone:601-946-8236
Mailing Address - Fax:
Practice Address - Street 1:405 GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2805
Practice Address - Country:US
Practice Address - Phone:601-946-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered