Provider Demographics
NPI:1376731315
Name:ROZIER, KELLY M (RD, LD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:ROZIER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3755
Mailing Address - Country:US
Mailing Address - Phone:469-383-8334
Mailing Address - Fax:888-356-0401
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3755
Practice Address - Country:US
Practice Address - Phone:469-383-8334
Practice Address - Fax:888-356-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196126001Medicaid
TX8X7873OtherBLUE CROSS BLUE SHIELD TX