Provider Demographics
NPI:1790928679
Name:HOFSESS, KELLY ANN (MSRDLD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:HOFSESS
Suffix:
Gender:F
Credentials:MSRDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE I.
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4276
Mailing Address - Country:US
Mailing Address - Phone:330-726-2440
Mailing Address - Fax:330-726-6844
Practice Address - Street 1:888 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE I.
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4276
Practice Address - Country:US
Practice Address - Phone:330-726-2440
Practice Address - Fax:330-726-6844
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2178133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered