Provider Demographics
NPI:1497323075
Name:KILGORE, CHELSEA CORSO (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:CORSO
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MIDDLE POND LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4343
Mailing Address - Country:US
Mailing Address - Phone:914-760-8890
Mailing Address - Fax:
Practice Address - Street 1:15 MIDDLE POND LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4343
Practice Address - Country:US
Practice Address - Phone:914-879-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist