Healthcare Provider Details

I. General information

NPI: 1659852481
Provider Name (Legal Business Name): KELSEY CHMIL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 VEGAS DE TAOS RD
TAOS NM
87571-4133
US

IV. Provider business mailing address

382 VEGAS DE TAOS RD
TAOS NM
87571-4133
US

V. Phone/Fax

Practice location:
  • Phone: 405-245-5722
  • Fax:
Mailing address:
  • Phone: 405-245-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-1238
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: