Provider Demographics
NPI:1912736018
Name:SUTHERLAND, KELCI (RD)
Entity type:Individual
Prefix:
First Name:KELCI
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S MONACO ST APT 2037
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3420
Mailing Address - Country:US
Mailing Address - Phone:423-416-0015
Mailing Address - Fax:
Practice Address - Street 1:4500 S MONACO ST APT 2037
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237
Practice Address - Country:US
Practice Address - Phone:423-416-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86345968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered