Provider Demographics
NPI:1538627682
Name:K AND F NUTRITION
Entity type:Organization
Organization Name:K AND F NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREYER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:860-744-4580
Mailing Address - Street 1:164 RIDGELAND CIR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2163
Mailing Address - Country:US
Mailing Address - Phone:860-744-4580
Mailing Address - Fax:
Practice Address - Street 1:164 RIDGELAND CIR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2163
Practice Address - Country:US
Practice Address - Phone:860-744-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service