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General NPI Number Information
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NPI Number | 1407638323
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Entity Type | Organization
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Legal Business Name | N-OF-1 PERSONALIZED NUTRITION, LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 400 HOSPITAL DR STE 104
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City | CORSICANA
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State | TX
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Zip | 75110-2489
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Country | US
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Telephone | 903-467-9921
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Fax |
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Provider Business Mailing Address
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Address Line | 25 DOBBINS XING
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City | CORSICANA
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State | TX
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Zip | 75110-2423
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Country | US
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Telephone | 903-467-9921
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID ANDREW KELLENBERGER
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Credential | RD, PA, DMS
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Telephone | 903-467-9921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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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 |
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License Number State |
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