Provider Demographics
NPI:1699528521
Name:HOLLEN, KEELEY (RDN)
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:HOLLEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47841-1116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 JACKSON ST
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IN
Practice Address - Zip Code:47841-1116
Practice Address - Country:US
Practice Address - Phone:812-241-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN370031B4A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered