Provider Demographics
NPI:1760785646
Name:WEINHOLD, KELLIE R (RD, LD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:R
Last Name:WEINHOLD
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 1:2050 KENNY RD
Mailing Address - Street 2:CENTER FOR WELLNESS AND PREVENTION
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3502
Mailing Address - Country:US
Mailing Address - Phone:614-293-2800
Mailing Address - Fax:614-293-2801
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:CENTER FOR WELLNESS AND PREVENTION
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-2800
Practice Address - Fax:614-293-2801
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.6681133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered