Provider Demographics
NPI:1861108250
Name:GARBUTT, KELSEY (RDN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:GARBUTT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:HILDRETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463 SPC ISAAC TRUJILLO DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-2241
Mailing Address - Country:US
Mailing Address - Phone:915-262-4498
Mailing Address - Fax:
Practice Address - Street 1:1382 LOMALAND DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-5204
Practice Address - Country:US
Practice Address - Phone:915-591-0834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered