Active NPI
Kelsey Marie Bruner, RD
- Registered Dietitian
- Newburgh, IN
National Provider Identifier
1255021135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 37003279A
- Practice address
- 4255 Medwell Drive
Newburgh, IN 47630-0010 - Phone
- (812) 853-2993
- NPI assigned
- May 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 37003279A | IN | Primary |
Addresses
Primary practice location
4255 Medwell Drive
Newburgh, IN 47630-0010
Mailing address
22 Quail Crossing Dr
Boonville, IN 47601-8466
Phone (812) 550-6941
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37003279A | IN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bradley Management LLC | Dietitian, Registered | Past | Accepting new patients |
| No Diet Dietitian, LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683849600000",
"number": "1255021135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 QUAIL CROSSING DR",
"city": "BOONVILLE",
"state": "IN",
"postal_code": "476018466",
"telephone_number": "812-550-6941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4255 MEDWELL DRIVE",
"city": "NEWBURGH",
"state": "IN",
"postal_code": "476300010",
"telephone_number": "812-853-2993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNER",
"first_name": "KELSEY",
"middle_name": "MARIE",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-12",
"last_updated": "2023-05-12",
"certification_date": "2023-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "37003279A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.