Provider Demographics
NPI:1952462277
Name:FLORES, KELLY A (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:FLORES
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1309 E TYLER AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7179
Mailing Address - Country:US
Mailing Address - Phone:956-440-7642
Mailing Address - Fax:956-440-7642
Practice Address - Street 1:1309 E TYLER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7179
Practice Address - Country:US
Practice Address - Phone:956-440-7642
Practice Address - Fax:956-440-7642
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT 04934133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT 04934OtherSTATE LICENSE