Healthcare Provider Details

I. General information

NPI: 1952587669
Provider Name (Legal Business Name): KELLI PASCHALL MS, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7202 SLIDE RD STE 303
LUBBOCK TX
79424-2553
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 135
LUBBOCK TX
79407-3544
US

V. Phone/Fax

Practice location:
  • Phone: 806-722-3110
  • Fax: 806-722-3115
Mailing address:
  • Phone: 806-785-7676
  • Fax: 806-722-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT03920
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: