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NPI Code Detail

MEDICARE: KELLEY MAY MESA MS,RD

MEDICARE: KELLEY MAY MESA MS,RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133NN1002XNutrition Education Nutritionist1051125CA
2133VN1004XPediatric Nutrition Registered Dietitian1051125CA
3133VN1005XRenal Nutrition Registered Dietitian1051125CA
4133VN1006XMetabolic Nutrition Registered Dietitian1051125CA
5133V00000XRegistered Dietitian1051125CA

General Provider Information

NPI Number : 1003310665
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY MAY MESA MS,RD
Provider Business Mailing Address
First Line : 408 N CEDAR BLUFF RD STE 305
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-3648
Country : US
Telephone Number : 805-465-9802
Fax Number : 805-512-8522
Provider Business Practice Location Address
First Line : 408 N CEDAR BLUFF RD STE 305
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-3648
Country : US
Telephone Number : 805-465-9802
Fax Number : 805-512-8522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 06/08/2022

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