Provider Demographics
NPI:1952587669
Name:PASCHALL, KELLI (MS, CDE)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:PASCHALL
Suffix:
Gender:F
Credentials:MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 135
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-7676
Mailing Address - Fax:806-722-2908
Practice Address - Street 1:7202 SLIDE RD
Practice Address - Street 2:STE 303
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2553
Practice Address - Country:US
Practice Address - Phone:806-722-3110
Practice Address - Fax:806-722-3115
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03920133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered