Kelli Ann Vivatson, LRD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

700 Issued in ND

Practice address

1200 S Columbia Rd
Grand Forks, ND 58201-4036

Phone

(701) 780-5000

Fax

(701) 780-1942

NPI assigned

Apr 25, 2007

Last updated

Jul 19, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelli Ann Vivaston Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184803200000",
    "number": "1740409044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6002",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582066002",
            "telephone_number": "701-780-5000",
            "fax_number": "701-780-1942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014036",
            "telephone_number": "701-780-5000",
            "fax_number": "701-780-1942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVATSON",
        "first_name": "KELLI",
        "middle_name": "ANN",
        "credential": "LRD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ND",
            "license": "700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "VIVASTON",
            "middle_name": "ANN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amanda Jean Vingelen, OTRL
• Isabel Theresa Virgille, OD
• Viscito Family Medicine, PLLC
• Vitas Laboratory LLC
• Brittany Marie Vittor, LICSW
• Kelsey Vivatson, PMHNP-BC, APRN
• Emily Kay Voeller, M.S., CFY-SLP
• Taylor Volberding
• Andrea Rachelle Volk, M.A, CCC-SLP
• Eden Volk, B MOD SPECIALIST

• Registered Dietitian in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Registered Dietitian in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; 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.