Provider Demographics
NPI:1538776422
Name:KEETHLER, MICHELE (RD LD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KEETHLER
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 1:240 N ROCK RD STE 303
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2246
Mailing Address - Country:US
Mailing Address - Phone:316-247-2462
Mailing Address - Fax:316-844-0018
Practice Address - Street 1:240 N ROCK RD STE 303
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2246
Practice Address - Country:US
Practice Address - Phone:316-247-2462
Practice Address - Fax:316-844-1647
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1037377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered