Provider Demographics
NPI:1003117730
Name:DEAN, KELSEY MICHELLE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:MICHELLE
Last Name:DEAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:MICHELLE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:RR 1 BOX 185
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:MO
Mailing Address - Zip Code:64723-8302
Mailing Address - Country:US
Mailing Address - Phone:660-200-5184
Mailing Address - Fax:913-588-2253
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 4004
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2937
Practice Address - Country:US
Practice Address - Phone:913-588-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered