MEDICARE: HEALTHY BY KELSEY NUTRITION COLLECTIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1003750001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY BY KELSEY NUTRITION COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	3091 COUNTRY CLUB RD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-9396
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3091 COUNTRY CLUB RD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-9396
Country	:	US
Telephone Number	:	325-656-5873
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	KELSEY WALLING
Credential	:
Telephone Number	:	325-656-5873

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	04/18/2026

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