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General NPI Number Information
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NPI Number | 1346213212
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Entity Type | Organization
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Legal Business Name | KINDERHOOK NUTRITION, LLC
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5 ROTHERMEL AVE
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City | KINDERHOOK
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State | NY
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Zip | 12106-2105
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Country | US
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Telephone | 518-758-8885
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Fax | 518-758-9390
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Provider Business Mailing Address
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Address Line | PO BOX 3
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City | KINDERHOOK
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State | NY
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Zip | 12106-0003
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Country | US
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Telephone | 518-758-8885
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Fax | 518-758-9390
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY VANALLEN-BRASWELL
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Credential | RD
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Telephone | 518-758-8885
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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 | 006035-1
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License Number State | NY
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