MEDICARE: KELSEY PEARSON MS, RD

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		UT

General Provider Information

NPI Number	:	1578062063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY PEARSON MS, RD

Provider Business Mailing Address
First Line	:	2084 E KARIN CT
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-7109
Country	:	US
Telephone Number	:	385-246-3936
Fax Number	:

Provider Business Practice Location Address
First Line	:	2084 E KARIN CT
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-7109
Country	:	US
Telephone Number	:	385-246-3936
Fax Number	:

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

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	02/09/2018

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