Provider Demographics
NPI:1316776214
Name:KELLER, NATALIE RENEE (RDN, LD, CD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENEE
Last Name:KELLER
Suffix:
Gender:F
Credentials:RDN, LD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7527
Mailing Address - Country:US
Mailing Address - Phone:270-925-1743
Mailing Address - Fax:
Practice Address - Street 1:1434 HICKORY LN
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7527
Practice Address - Country:US
Practice Address - Phone:270-925-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY850367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered