Provider Demographics
NPI:1285682427
Name:WESTERCAMP, KELLIE A (RD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:WESTERCAMP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2739
Mailing Address - Country:US
Mailing Address - Phone:712-792-4000
Mailing Address - Fax:712-792-3554
Practice Address - Street 1:515 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2739
Practice Address - Country:US
Practice Address - Phone:712-792-4000
Practice Address - Fax:712-792-3554
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01704133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71934OtherMEDICARE GROUP NUMBER