Provider Demographics
NPI:1437558616
Name:BAIR, KELSEY (RD, LMNT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BAIR
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2831
Mailing Address - Country:US
Mailing Address - Phone:308-236-0020
Mailing Address - Fax:
Practice Address - Street 1:5212 3RD AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2831
Practice Address - Country:US
Practice Address - Phone:308-236-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered