Provider Demographics
NPI:1083624910
Name:CHAMBERS, KELLY EVARTS (RD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:EVARTS
Last Name:CHAMBERS
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 1:1526 NUNAMAKER RD
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-8513
Mailing Address - Country:US
Mailing Address - Phone:541-490-8603
Mailing Address - Fax:
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1204
Practice Address - Country:US
Practice Address - Phone:541-387-6379
Practice Address - Fax:541-387-6142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR449133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered