Provider Demographics
NPI:1316057102
Name:SCHENK, KELLI L (RD/LD)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:L
Last Name:SCHENK
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HENNESSEY
Mailing Address - State:OK
Mailing Address - Zip Code:73742-1711
Mailing Address - Country:US
Mailing Address - Phone:405-853-4671
Mailing Address - Fax:405-853-4671
Practice Address - Street 1:200 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1711
Practice Address - Country:US
Practice Address - Phone:405-853-4671
Practice Address - Fax:405-853-4671
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1188133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist