MEDICARE: MS. KELLY ANN BYSURA 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

General Provider Information

NPI Number	:	1790838217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY ANN BYSURA RD

Provider Business Mailing Address
First Line	:	530 CRAFT LN
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-7158
Country	:	US
Telephone Number	:	423-972-1788
Fax Number	:

Provider Business Practice Location Address
First Line	:	GREENE COUNTY HEALTH DEPARTMENT
Second Line	:	810 WEST CHURCH STREET
City	:	GREENEVILLE
State	:	TN
Zip	:	37744
Country	:	US
Telephone Number	:	423-798-1749
Fax Number	:	423-798-1755

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	05/13/2025

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