Provider Demographics
NPI:1417661059
Name:TRUE, KELSEY MICHELE (RD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELE
Last Name:TRUE
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 1:663 E VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1856
Mailing Address - Country:US
Mailing Address - Phone:618-531-6904
Mailing Address - Fax:
Practice Address - Street 1:663 E VANDALIA ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1856
Practice Address - Country:US
Practice Address - Phone:618-531-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered