Provider Demographics
NPI:1114655503
Name:SLOAN, KELLY E (MS, RDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17257 BIRDS FOOT TRL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4630
Mailing Address - Country:US
Mailing Address - Phone:562-704-0024
Mailing Address - Fax:
Practice Address - Street 1:18500 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9504
Practice Address - Country:US
Practice Address - Phone:720-847-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI86034019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered