Provider Demographics
NPI:1003394958
Name:KELLE, PAMELA JEAN (RDN, CEDRD, LD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:KELLE
Suffix:
Gender:F
Credentials:RDN, CEDRD, LD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:KELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, CEDRD, LD
Mailing Address - Street 1:1238 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3020
Mailing Address - Country:US
Mailing Address - Phone:423-991-3422
Mailing Address - Fax:
Practice Address - Street 1:1238 HANOVER ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3020
Practice Address - Country:US
Practice Address - Phone:423-991-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered