Provider Demographics
NPI:1083095301
Name:WERTH, KELSEY (RD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WERTH
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 1:2420 OWENS AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7188
Mailing Address - Country:US
Mailing Address - Phone:785-259-2425
Mailing Address - Fax:
Practice Address - Street 1:2420 OWENS AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-7188
Practice Address - Country:US
Practice Address - Phone:785-259-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86026746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered