Provider Demographics
NPI:1013802834
Name:BANKES, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BANKES
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 GARRETT SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:PA
Mailing Address - Zip Code:15542-9108
Mailing Address - Country:US
Mailing Address - Phone:301-852-0930
Mailing Address - Fax:301-852-0930
Practice Address - Street 1:325 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-2016
Practice Address - Country:US
Practice Address - Phone:301-852-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered