NPIMap

Organization Active NPI

Ellad Nutrition Consulting, LLC

Doing business as ELLAD Preventative Health Services

  • Multi-Specialty Clinic/Center
  • Chesterfield, VA
National Provider Identifier
1700123064
Registry record updated Jan 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ELLAD NUTRITION CONSULTING, LLC
Doing business as
ELLAD Preventative Health Services
EPH Mental Health Services
Practice address
9401 Courthouse Rd Ste 202
Chesterfield, VA 23832-6687
Phone
(804) 616-4378
Fax
(804) 451-4586
NPI assigned
Jan 7, 2013
Last updated
Jan 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tyra L Tanner, DNP,ANP,CNS,MSN, RDNPI 1326340928
Title
Clinical Director
Phone
(804) 616-4378

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Nurse Practitioner 363L00000X NU
Adult Health Nurse Practitioner 363LA2200X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Clinical Nurse Specialist 364S00000X NU
Registered Dietitian 133V00000X NU

Addresses

Primary practice location

9401 Courthouse Rd Ste 202
Chesterfield, VA 23832-6687

Mailing address

PO Box 2947
Chesterfield, VA 23832-9118
Phone (804) 616-4378

Other names 2

  • ELLAD Preventative Health Services Doing business as
  • EPH Mental Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130123000135 VA Part B Supplier - Clinic/Group Practice 8123271236 Receives reassigned benefits from 5 practitioners
Practice locations: Chesterfield, VA

National Provider Directory

National Provider Directory

Locations

9401 Courthouse Rd
Ste 202
Chesterfield, VA 23832
Phone (804) 533-7444

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736553600000",
    "number": "1700123064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2947",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238329118",
            "telephone_number": "804-616-4378",
            "fax_number": "804-616-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 COURTHOUSE RD STE 202",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326687",
            "telephone_number": "804-616-4378",
            "fax_number": "804-451-4586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLAD NUTRITION CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-07",
        "last_updated": "2025-01-11",
        "certification_date": "2025-01-11",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "TYRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "804-616-4378",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP,ANP,CNS,MSN, RD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELLAD Preventative Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EPH Mental Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.