Provider Demographics
NPI:1275220055
Name:DEMARTE, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DEMARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 VACQUERO CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9138
Mailing Address - Country:US
Mailing Address - Phone:720-525-1977
Mailing Address - Fax:
Practice Address - Street 1:6063 VACQUERO CIR
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9138
Practice Address - Country:US
Practice Address - Phone:720-525-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist