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General NPI Number Information
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NPI Number | 1952783540
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Entity Type | Individual
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Provider Name | KELLY M DUNN BS, LD, RDN, CNSC
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1201 CAMINO DE SALUD NE MSC07 4025
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-1721
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Country | US
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Telephone | 505-925-1114
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Fax | 505-925-0100
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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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 | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | DT83685
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number | LD-1340
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 916298
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License Number State |
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