Provider Demographics
NPI:1871086207
Name:ERWIN, SARAH KELLY (RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KELLY
Last Name:ERWIN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 TWIN LAKES RD # A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9619
Mailing Address - Country:US
Mailing Address - Phone:601-481-5465
Mailing Address - Fax:
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-968-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1833133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered