Provider Demographics
NPI:1952783540
Name:DUNN, KELLY M (BS, LD, RDN, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:DUNN
Suffix:
Gender:F
Credentials:BS, LD, RDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-4946
Mailing Address - Fax:505-925-0100
Practice Address - Street 1:1201 CAMINO DE SALUD NE MSC07 4025
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-1721
Practice Address - Country:US
Practice Address - Phone:505-925-1114
Practice Address - Fax:505-925-0100
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
916298133V00000X
TXDT83685133VN1004X
NMLD-1340133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric