Provider Demographics
NPI:1083630800
Name:JENNINGS, KELLI RAE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RAE
Last Name:JENNINGS
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 1:142 SHAVANO ST
Mailing Address - Street 2:PO BOX 2074
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-9621
Mailing Address - Country:US
Mailing Address - Phone:970-349-0767
Mailing Address - Fax:970-349-1251
Practice Address - Street 1:142 SHAVANO ST
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-9621
Practice Address - Country:US
Practice Address - Phone:970-349-0767
Practice Address - Fax:970-349-1251
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered