Kelly Potysman Fisher, DCN, RD, LD, FNAP
Individual provider Active NPI Registered Dietitian · Aledo, TX
NPI 1750110714 · NPPES record last updated Jul 29, 2024
Key facts
- NPI
- 1750110714
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT81572 (TX)
- Practice address
- 1304 Greenleaf Dr
Aledo, TX 76008-2840 - Phone
- (817) 846-3104
- NPI assigned
- Jul 29, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT81572 | TX | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT81572 | TX | Yes |
Addresses
Primary practice location
1304 Greenleaf Dr
Aledo, TX 76008-2840
Mailing address
1304 Greenleaf Dr
Aledo, TX 76008-2840
Phone (817) 846-3104
Other providers in Aledo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2024. 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.