Provider Demographics
NPI:1982135224
Name:BAKER, KELLI (MS, HNFM)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, HNFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 KEN PRATT BLVD
Mailing Address - Street 2:SUITE 120 PMB1
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8993
Mailing Address - Country:US
Mailing Address - Phone:720-483-6336
Mailing Address - Fax:
Practice Address - Street 1:205 KEN PRATT BLVD
Practice Address - Street 2:SUITE 120 PMB1
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8993
Practice Address - Country:US
Practice Address - Phone:720-483-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist