Provider Demographics
NPI:1033715727
Name:ESTERLINE, KELLY NICOLE (RDN, LN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:NICOLE
Last Name:ESTERLINE
Suffix:
Gender:F
Credentials:RDN, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SE 39TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8338
Mailing Address - Country:US
Mailing Address - Phone:239-910-3871
Mailing Address - Fax:
Practice Address - Street 1:9400 GLADIOLUS DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3692
Practice Address - Country:US
Practice Address - Phone:239-482-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10167OtherFLORIDA DEPARTMENT OF HEALTH