Provider Demographics
NPI:1124157508
Name:KENWORTHY, ELSA ELENA (MS, RD,, LDN, CDE)
Entity type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:ELENA
Last Name:KENWORTHY
Suffix:
Gender:F
Credentials:MS, RD,, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 CHILDRESS LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5330
Mailing Address - Country:US
Mailing Address - Phone:972-390-8144
Mailing Address - Fax:
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7939
Practice Address - Country:US
Practice Address - Phone:972-981-8116
Practice Address - Fax:972-981-8453
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered