Provider Demographics
NPI:1194237727
Name:ISOM, KELLENE ANNE (PHD, MS, RD, CAGS)
Entity type:Individual
Prefix:DR
First Name:KELLENE
Middle Name:ANNE
Last Name:ISOM
Suffix:
Gender:F
Credentials:PHD, MS, RD, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4052 GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2313
Mailing Address - Country:US
Mailing Address - Phone:857-498-2524
Mailing Address - Fax:
Practice Address - Street 1:4052 GAREY AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2313
Practice Address - Country:US
Practice Address - Phone:857-498-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management