MEDICARE: MADISON KELLEY

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1124985627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON KELLEY

Provider Business Mailing Address
First Line	:	2911 TEXAS AVE S STE 1000B
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-1184
Country	:	US
Telephone Number	:	800-465-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 TEXAS AVE S STE 1000B
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-1184
Country	:	US
Telephone Number	:	800-465-3203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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