Provider Demographics
NPI:1013597921
Name:CHEVES, KELLIE SUMMER (RD)
Entity Type:Individual
Prefix:MISS
First Name:KELLIE
Middle Name:SUMMER
Last Name:CHEVES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 CALLE DE LA MANCHA
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8600
Mailing Address - Country:US
Mailing Address - Phone:925-209-3510
Mailing Address - Fax:
Practice Address - Street 1:6524 CALLE DE LA MANCHA
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8600
Practice Address - Country:US
Practice Address - Phone:925-209-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered