Carli J Elliott, RD, LD

Key facts

NPI

1972360741

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Nutrition Registered Dietitian 133VN1004X

License

2023035539 (MO)

Practice address

1465 S Grand Blvd
Saint Louis, MO 63104-1003

Phone

(314) 577-5600

NPI assigned

Feb 28, 2024

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 28, 2024.

{
    "created_epoch": "1709078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1972360741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "CARLI",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "RD, LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "MO",
            "license": "2023035539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

• Aubrey Lyn Ellinger
• Angel Angelette Rochelle Ellington
• Justin Ross Ellingworth, CAA
• Elliot L Korn MD Inc
• Rod Lee Elliott-Mullens, DO
• Christopher Elliott, LCSW
• Crystal Renee Elliott, LPN
• Darcey Alana Elliott, PA
• Justin Dwayne Elliott, ACNP
• Kevin Elliott, M.D.

All providers in Saint Louis, MO · Pediatric Nutrition Registered Dietitian in Missouri