Provider Demographics
NPI:1003366865
Name:DUNCAN, KELSEY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:JETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-951-2131
Mailing Address - Fax:405-951-2135
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:#970
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-951-2131
Practice Address - Fax:405-951-2135
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered