Provider Demographics
NPI:1447565619
Name:HURST, KELI ANNE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KELI
Middle Name:ANNE
Last Name:HURST
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 1:9811 N WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2131
Mailing Address - Country:US
Mailing Address - Phone:913-634-8037
Mailing Address - Fax:
Practice Address - Street 1:207 NE ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4586
Practice Address - Country:US
Practice Address - Phone:816-454-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000892133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered