Healthcare Provider Details

I. General information

NPI: 1609397454
Provider Name (Legal Business Name): KELSEY HUTTER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2017
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE STE 215
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVE STE 215
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-5901
  • Fax: 412-578-5902
Mailing address:
  • Phone: 412-578-5901
  • Fax: 412-578-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004005
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: