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General NPI Number Information
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NPI Number | 1255655569
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Entity Type | Individual
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Provider Name | KELLY V TSOUGAS M.S., R.D., L.D.N
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Gender | Female
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 5410 S ASHCROFT WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-6866
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Country | US
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Telephone | 919-601-3919
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Fax | 919-705-1626
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Provider Business Mailing Address
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Address Line | 5410 S ASHCROFT WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-6866
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Country | US
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Telephone | 919-601-3919
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Fax | 919-705-1626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-1494
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 40194-DI-0
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L003573
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 59.003273
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2713
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License Number State | KS
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Taxonomy #6
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164008832
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License Number State | IL
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