Provider Demographics
NPI:1588185896
Name:WEEDEN, KELSEY DIANE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:DIANE
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WEBSTER PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2336
Mailing Address - Country:US
Mailing Address - Phone:678-773-1955
Mailing Address - Fax:
Practice Address - Street 1:10400 MALLARD CREEK CHURCH ROAD, SUITE 340
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:678-773-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1047000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered