Provider Demographics
NPI:1396160826
Name:GRAMS, KELSAY MARY (RD)
Entity type:Individual
Prefix:MRS
First Name:KELSAY
Middle Name:MARY
Last Name:GRAMS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KELSAY
Other - Middle Name:MARY
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4801 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2015
Mailing Address - Country:US
Mailing Address - Phone:320-252-1670
Mailing Address - Fax:320-654-7650
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:320-252-1670
Practice Address - Fax:320-654-7650
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3327133V00000X
MN1090652133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered