Provider Demographics
NPI:1679867980
Name:KEILTY, KIRSTIN ANN (MS, CNS)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:ANN
Last Name:KEILTY
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 BAY CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7187
Mailing Address - Country:US
Mailing Address - Phone:702-266-7279
Mailing Address - Fax:702-562-3775
Practice Address - Street 1:8441 BAY CREST DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7187
Practice Address - Country:US
Practice Address - Phone:702-266-7279
Practice Address - Fax:702-562-3775
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7010133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education