Provider Demographics
NPI:1689677569
Name:DROTZ, KEELEY C (RDN (REGISTERED DIET)
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:C
Last Name:DROTZ
Suffix:
Gender:F
Credentials:RDN (REGISTERED DIET
Other - Prefix:
Other - First Name:KEELEY
Other - Middle Name:C
Other - Last Name:CAVENDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5913 WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-8034
Mailing Address - Country:US
Mailing Address - Phone:253-678-2154
Mailing Address - Fax:253-435-7569
Practice Address - Street 1:5531 VIRGINIA PARKWAY, SUITE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8034
Practice Address - Country:US
Practice Address - Phone:253-678-2154
Practice Address - Fax:253-435-7569
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001453133N00000X
TXDT83586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7280595OtherAETNA PPO, POS, EPO
WA8802494Medicare ID - Type Unspecified
WA3611555OtherAETNA HMO, QPOS, USACCESS
WAQ11865Medicare UPIN
WA1011DROtherREGENCE BLUESHIELD
WA7601073Medicaid