Provider Demographics
NPI:1194817742
Name:KELLI R JENNINGS
Entity Type:Organization
Organization Name:KELLI R JENNINGS
Other - Org Name:APEX NUTRITION LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:970-349-0767
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:142 SHAVANO ST.
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-2074
Mailing Address - Country:US
Mailing Address - Phone:970-349-0767
Mailing Address - Fax:
Practice Address - Street 1:142 SHAVANO
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO806482Medicare PIN