MEDICARE: KELSEY SCHOENBACHER MS, RD, LD

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	133VN1005X	Renal Nutrition Registered Dietitian	DT83669	TX

General Provider Information

NPI Number	:	1700383866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY SCHOENBACHER MS, RD, LD

Provider Business Mailing Address
First Line	:	5502 SARATOGA BLVD APT 128
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2964
Country	:	US
Telephone Number	:	815-307-6924
Fax Number	:

Provider Business Practice Location Address
First Line	:	5502 SARATOGA BLVD APT 128
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2964
Country	:	US
Telephone Number	:	815-307-6924
Fax Number	:

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

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/06/2018

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