Healthcare Provider Details

I. General information

NPI: 1700767407
Provider Name (Legal Business Name): KELSEY MUELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514-2499
US

IV. Provider business mailing address

600 EAST BLVD
ELKHART IN
46514-2499
US

V. Phone/Fax

Practice location:
  • Phone: 574-389-5611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37004397A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: