Healthcare Provider Details

I. General information

NPI: 1689755050
Provider Name (Legal Business Name): SARA KELSEY BORN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-3737
US

IV. Provider business mailing address

6300 S.W. GRANDOAKS DR. #K201
CORVALLIS OR
97333
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4663
  • Fax:
Mailing address:
  • Phone: 541-740-6899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: