Provider Demographics
NPI:1295562429
Name:KELLER, SARAH (MCN, RD, LD, CNSC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:MCN, RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7233 DALEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1814
Mailing Address - Country:US
Mailing Address - Phone:817-992-6011
Mailing Address - Fax:
Practice Address - Street 1:7233 DALEWOOD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-1814
Practice Address - Country:US
Practice Address - Phone:817-992-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83833133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered