Provider Demographics
NPI:1043587801
Name:TROUTT, KELLY GOSNELL (RD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:GOSNELL
Last Name:TROUTT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:SUZANNE
Other - Last Name:GOSNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:555 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2400
Mailing Address - Country:US
Mailing Address - Phone:615-328-5526
Mailing Address - Fax:615-328-6132
Practice Address - Street 1:555 HARTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2400
Practice Address - Country:US
Practice Address - Phone:615-328-5526
Practice Address - Fax:615-328-6132
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1715133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered