Healthcare Provider Details

I. General information

NPI: 1598749723
Provider Name (Legal Business Name): KELLY M TARPLEY RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W OLLIE ST
LLANO TX
78643-2628
US

IV. Provider business mailing address

200 W OLLIE ST
LLANO TX
78643-2628
US

V. Phone/Fax

Practice location:
  • Phone: 325-247-5040
  • Fax: 325-248-2108
Mailing address:
  • Phone: 325-247-5040
  • Fax: 325-248-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT05809
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: