Healthcare Provider Details

I. General information

NPI: 1003117730
Provider Name (Legal Business Name): KELSEY MICHELLE DEAN M.S., R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY MICHELLE LEWIS M.S., R.D., L.D.

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MAIL STOP 4004
KANSAS CITY KS
66103-2937
US

IV. Provider business mailing address

RR 1 BOX 185
AMSTERDAM MO
64723-8302
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-3775
  • Fax:
Mailing address:
  • Phone: 660-200-5184
  • Fax: 913-588-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1584
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: