Keely Bourassa, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

37003359A Issued in IN

Practice address

1200 S Center St
Terre Haute, IN 47802-1118

Phone

(317) 753-7308

NPI assigned

Apr 14, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Carmel Therapy LLC

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  • NPI 1386345957

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1417643149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S CENTER ST",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478021118",
            "telephone_number": "317-753-7308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S CENTER ST",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478021118",
            "telephone_number": "317-753-7308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURASSA",
        "first_name": "KEELY",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "IN",
            "license": "37003359A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lesli Bose
• Kylee L Bosstick
• Ian Nicholas Bostock
• Andro Botros
• Jonah Bourassa
• Margaret Bourne, MFT
• Kelsey Bowlds
• Angela Bowles
• Brynna Kathryn Bowman
• Jeremy Bowman, MSN, APRN, FNP-BC

• All providers in Terre Haute, IN
• Registered Dietitian in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.

Verify at the official NPI Registry.