Healthcare Provider Details

I. General information

NPI: 1023663531
Provider Name (Legal Business Name): KALEIGH MICHEL TJOELKER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALEIGH MICHEL CARPENTER

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.08810
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: