Provider Demographics
NPI:1598749723
Name:TARPLEY, KELLY M (RD LD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:TARPLEY
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 1:200 W OLLIE ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2628
Mailing Address - Country:US
Mailing Address - Phone:325-247-5040
Mailing Address - Fax:325-248-2108
Practice Address - Street 1:200 W OLLIE ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2628
Practice Address - Country:US
Practice Address - Phone:325-247-5040
Practice Address - Fax:325-248-2108
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05809133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154190601Medicaid
TX8K5359OtherBCBS
TX10013547OtherAMERIGROUP
TX10013547OtherAMERIGROUP
TXTXB127450Medicare PIN
TX8K5359OtherBCBS