Provider Demographics
NPI:1841928074
Name:GRIFFIN, KELSEY ANN (RDN, LDN, CNSC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RDN, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 E EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2827
Mailing Address - Country:US
Mailing Address - Phone:626-388-5474
Mailing Address - Fax:
Practice Address - Street 1:2429 E EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-2827
Practice Address - Country:US
Practice Address - Phone:626-388-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40265-DIE-0133V00000X
MO2021004969133V00000X
FL10762133V00000X
LA3230133V00000X
CA86002565133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered