Provider Demographics
NPI:1063964724
Name:MCPHERSON, ELISA KAY (RDN, CD)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:KAY
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 IVYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-1929
Mailing Address - Country:US
Mailing Address - Phone:574-377-3289
Mailing Address - Fax:
Practice Address - Street 1:2838 IVYWOOD DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-1929
Practice Address - Country:US
Practice Address - Phone:574-377-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000528A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered