Provider Demographics
NPI:1093399388
Name:MARTINEZ PRATTS, KELLY BRIDGET (LND)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:BRIDGET
Last Name:MARTINEZ PRATTS
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#501 CALLE AZUCENA URB EL ENCANTO
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-428-8176
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE MIGUEL CASILLAS
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3638
Practice Address - Country:US
Practice Address - Phone:787-285-5959
Practice Address - Fax:787-285-8811
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2170133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education