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General NPI Number Information
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NPI Number | 1427960020
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Entity Type | Individual
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Provider Name | KELLY BRUNELLE MS RD
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Gender | Female
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 2409 COOL SPRINGS DR S
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7189
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Country | US
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Telephone | 281-253-0859
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 COOL SPRINGS DR S
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7189
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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 | DT92504
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License Number State | TX
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