Healthcare Provider Details

I. General information

NPI: 1093399388
Provider Name (Legal Business Name): KELLY BRIDGET MARTINEZ PRATTS LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CALLE MIGUEL CASILLAS
HUMACAO PR
00791-3638
US

IV. Provider business mailing address

#501 CALLE AZUCENA URB EL ENCANTO
JUNCOS PR
00777
US

V. Phone/Fax

Practice location:
  • Phone: 787-285-5959
  • Fax: 787-285-8811
Mailing address:
  • Phone: 787-428-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2170
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2170
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: