MEDICARE: MRS. KELLY KRISTINE CHANAY R.D.

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
1	133V00000X	Registered Dietitian	964	KS
2	133V00000X	Registered Dietitian	ND4711	FL

General Provider Information

NPI Number	:	1477733293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY KRISTINE CHANAY R.D.

Provider Business Mailing Address
First Line	:	1713 PEPPERWOOD CT
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3775
Country	:	US
Telephone Number	:	620-275-4794
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 PEPPERWOOD CT
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3775
Country	:	US
Telephone Number	:	620-275-4794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/08/2007

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