Provider Demographics
NPI:1689927071
Name:VARGAS, KELSEY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 PACCO LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4823
Mailing Address - Country:US
Mailing Address - Phone:936-537-6606
Mailing Address - Fax:
Practice Address - Street 1:504 SPRING HILL DR
Practice Address - Street 2:SUITE 450
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-6027
Practice Address - Country:US
Practice Address - Phone:936-537-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered