Provider Demographics
NPI:1780119206
Name:SCHMITT, KELSEY (RD, CD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 CANYON VIEW PR NE
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320
Mailing Address - Country:US
Mailing Address - Phone:206-883-1760
Mailing Address - Fax:
Practice Address - Street 1:3311 W CLEARWATER AVE
Practice Address - Street 2:D-222
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2710
Practice Address - Country:US
Practice Address - Phone:206-883-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60599049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered