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General NPI Number Information
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NPI Number | 1538776422
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Entity Type | Individual
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Provider Name | MICHELE KEETHLER RD LD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 240 N ROCK RD STE 303
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City | WICHITA
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State | KS
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Zip | 67206-2246
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Country | US
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Telephone | 316-247-2462
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Fax | 316-844-1647
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Provider Business Mailing Address
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Address Line | 240 N ROCK RD STE 303
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City | WICHITA
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State | KS
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Zip | 67206-2246
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Country | US
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Telephone | 316-247-2462
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Fax | 316-844-0018
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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 | 1037377
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License Number State | KS
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