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General NPI Number Information
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NPI Number | 1265838429
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Entity Type | Individual
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Provider Name | KELSEY PHIPPEN RD, LD, LMNT
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Gender | Female
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 1745 MADISON AVE
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-5249
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Country | US
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Telephone | 712-322-9260
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Fax |
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Provider Business Mailing Address
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Address Line | 11 BAYBERRY CIR
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-5401
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Country | US
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Telephone |
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Fax |
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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 | 075686
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License Number State | IA
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