Provider Demographics
NPI:1598376923
Name:DWYER, KELLY P (MNT, BCHN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:P
Last Name:DWYER
Suffix:
Gender:F
Credentials:MNT, BCHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4523
Mailing Address - Country:US
Mailing Address - Phone:303-570-5679
Mailing Address - Fax:
Practice Address - Street 1:121 S MADISON ST STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3019
Practice Address - Country:US
Practice Address - Phone:303-570-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist