MEDICARE: KELSEY BIGBEE 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
1	133V00000X	Registered Dietitian	4325	MN

General Provider Information

NPI Number	:	1659122547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY BIGBEE RD

Provider Business Mailing Address
First Line	:	2211 CLARE DR
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-3406
Country	:	US
Telephone Number	:	507-317-6128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 CLARE DR
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-3406
Country	:	US
Telephone Number	:	507-317-6128
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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