Provider Demographics
NPI:1659531424
Name:WELCH, KEIRSTEN MICHELLE (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:KEIRSTEN
Middle Name:MICHELLE
Last Name:WELCH
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 COURTNEY PL
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8987
Mailing Address - Country:US
Mailing Address - Phone:614-352-8348
Mailing Address - Fax:740-548-3091
Practice Address - Street 1:2709 COURTNEY PL
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8987
Practice Address - Country:US
Practice Address - Phone:614-352-8348
Practice Address - Fax:740-548-3091
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered