Provider Demographics
NPI:1265695696
Name:HUNTER, KELSIE JEAN (RD, CD)
Entity type:Individual
Prefix:MS
First Name:KELSIE
Middle Name:JEAN
Last Name:HUNTER
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 220TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4440
Mailing Address - Country:US
Mailing Address - Phone:425-482-4119
Mailing Address - Fax:425-482-4249
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S CHC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:425-482-4119
Practice Address - Fax:425-482-4249
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00001550133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
897513OtherCOMMISSION ON DIETETIC REGISTRATION
WADI 00001550OtherWASHINGTON STATE DEPARTMENT OF HEALTH