Provider Demographics
NPI:1568607570
Name:KOELSCH, RYAN P (BS, MS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:P
Last Name:KOELSCH
Suffix:
Gender:M
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DRIVE
Mailing Address - Street 2:NUTRITION CARE DIVISION
Mailing Address - City:FT. CAMPBELL
Mailing Address - State:TN
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-8080
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DRIVE
Practice Address - Street 2:NUTRITION CARE DIVISION
Practice Address - City:FT. CAMPBELL
Practice Address - State:TN
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered