Kelley Blasa, RD, LDN
Individual provider Active NPI Registered Dietitian · Hannibal, MO
NPI 1700055100 · NPPES record last updated Feb 29, 2008
Key facts
- NPI
- 1700055100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- Practice address
- 11197 W Lakeshore Dr
Hannibal, MO 63401-7386 - Phone
- (573) 221-1354
- NPI assigned
- Feb 29, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.003082 | IL | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | IL | Yes |
Addresses
Primary practice location
11197 W Lakeshore Dr
Hannibal, MO 63401-7386
Mailing address
11197 W Lakeshore Dr
Hannibal, MO 63401-7386
Other providers in Hannibal, MO
- Beth Haven Group Homes Inc
- Christopher Michael Bieniek
- Taylor Renee Bieniek
- Kory Dane Blank
- Rebekah Marie Blank
- Kae Lynn Blecha
- Blessing Hospital
- Blessing Hospital
- Blessing Hospital
- Blessing Hospital
All providers in Hannibal, MO · Registered Dietitian in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.