Healthcare Provider Details

I. General information

NPI: 1982302352
Provider Name (Legal Business Name): KELSIE MATTHEWS RDN, LD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSIE ANDREWS RDN, LD, CNSC

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7609 PRESTON RD
PLANO TX
75024-3415
US

IV. Provider business mailing address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 469-303-7000
  • Fax:
Mailing address:
  • Phone: 214-456-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberDT83986
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT83986
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: