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NPI Code Detail

MEDICARE: KELSEY BIRD RD

MEDICARE: KELSEY BIRD 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
1133V00000XRegistered Dietitian86049941UT
2133V00000XRegistered Dietitian115284934901UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154829109
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY BIRD RD
Provider Business Mailing Address
First Line : PO BOX 5546
Second Line :
City : DENVER
State : CO
Zip : 80217-5546
Country : US
Telephone Number : 801-475-3500
Fax Number :
Provider Business Practice Location Address
First Line : 1916 N 700 W STE 250
Second Line :
City : LAYTON
State : UT
Zip : 84041-5723
Country : US
Telephone Number : 801-479-0312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2018
Last Update Date : 03/30/2021

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Directions to “ KELSEY BIRD RD” Practice Location

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