Doctor Name: | KELLY LYNNETTE NUCKOLLS |
NPI Number: | 1548560667 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS RD |
License Number: | 976210 |
Business Practice Address: | 600 Highland Ave Mc 2433 Madison, WI - 537921530 |
Business Phone Number: | 6086620817 |
Business Fax Number: | |
Mailing Address: | 600 Highland Ave, Mc 2433 MADISON |
State: | WI |
Postal Code: | 537921530 |
Phone Number: | 6086620817 |
Fax Number: | |
NPI Enumeration Date: | 10/22/2010 |
NPI Last Update Date: | 10/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 976210 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |