Healthcare Provider Details

I. General information

NPI: 1922693316
Provider Name (Legal Business Name): KELSEY BROWN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTHRIDGE LN
LEXINGTON VA
24450-3399
US

IV. Provider business mailing address

306 MASSIE ST
LEXINGTON VA
24450-2716
US

V. Phone/Fax

Practice location:
  • Phone: 540-464-8700
  • Fax:
Mailing address:
  • Phone: 919-280-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: