Provider Demographics
NPI:1124358288
Name:ERMELS, KELSEY N (RDLD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:N
Last Name:ERMELS
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IA
Mailing Address - Zip Code:50212-1034
Mailing Address - Country:US
Mailing Address - Phone:515-577-1411
Mailing Address - Fax:
Practice Address - Street 1:311 S CLARK STREET
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-0628
Practice Address - Country:US
Practice Address - Phone:712-792-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001907133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered