Provider Demographics
NPI:1982068003
Name:KAUFERT, KELLY
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:KAUFERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9506 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-5707
Mailing Address - Country:US
Mailing Address - Phone:916-337-5065
Mailing Address - Fax:
Practice Address - Street 1:9506 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-5707
Practice Address - Country:US
Practice Address - Phone:916-337-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered