Provider Demographics
NPI:1841727989
Name:PATTERSON, KELSIE (RDN, LD, CDCES)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RDN, LD, CDCES
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD, CDCES
Mailing Address - Street 1:5517 COUNTY ROAD 803
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-5214
Mailing Address - Country:US
Mailing Address - Phone:940-441-2430
Mailing Address - Fax:
Practice Address - Street 1:5517 COUNTY ROAD 803
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-5214
Practice Address - Country:US
Practice Address - Phone:940-441-2430
Practice Address - Fax:800-782-6249
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21701029163WD0400X
133V00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty