Provider Demographics
NPI:1588557854
Name:FENTON, KELSEY BROOKE (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:BROOKE
Last Name:FENTON
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:BROOKE
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:28 KELLOGG RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 KELLOGG RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3113
Practice Address - Country:US
Practice Address - Phone:607-283-9753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012782-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered