Provider Demographics
NPI:1497490866
Name:KELLER, DENISE MARION (RD)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARION
Last Name:KELLER
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 1:120 BLACKSMITH ARCH
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4506
Mailing Address - Country:US
Mailing Address - Phone:757-927-0215
Mailing Address - Fax:757-865-9540
Practice Address - Street 1:13195 WARWICK BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8313
Practice Address - Country:US
Practice Address - Phone:757-570-6588
Practice Address - Fax:757-534-7801
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered