Provider Demographics
NPI:1851967228
Name:HOJARA, KELSEY (RD, LD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HOJARA
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 1:1702 S BUFFSTONE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-7703
Mailing Address - Country:US
Mailing Address - Phone:574-329-4326
Mailing Address - Fax:
Practice Address - Street 1:1702 S BUFFSTONE CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-7703
Practice Address - Country:US
Practice Address - Phone:574-329-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003084A133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic