Provider Demographics
NPI:1346820446
Name:KELLIE CHEVES
Entity Type:Organization
Organization Name:KELLIE CHEVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:SUMMER
Authorized Official - Last Name:CHEVES
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:925-209-3510
Mailing Address - Street 1:6524 CALLE DE LA MANCHA
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8600
Mailing Address - Country:US
Mailing Address - Phone:925-209-3510
Mailing Address - Fax:
Practice Address - Street 1:6524 CALLE DE LA MANCHA
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8600
Practice Address - Country:US
Practice Address - Phone:925-209-3510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty