Provider Demographics
NPI:1639990237
Name:KELEHER, QUINN REILEY (RD)
Entity type:Individual
Prefix:
First Name:QUINN
Middle Name:REILEY
Last Name:KELEHER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 BILBERRY ST APT 209
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3201
Mailing Address - Country:US
Mailing Address - Phone:712-574-3507
Mailing Address - Fax:
Practice Address - Street 1:3725 BILBERRY ST APT 209
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3201
Practice Address - Country:US
Practice Address - Phone:712-574-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered