Kelly Joy Quisenberry, RD LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

268 Issued in AK

Practice address

4320 Diplomacy Dr Ste 3181
Southcentral Foundation
Anchorage, AK 99508-5925

Phone

(907) 729-4371

Fax

(907) 729-4135

NPI assigned

Jun 7, 2011

Last updated

Mar 27, 2014By 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 identifiers 1

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": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395878400000",
    "number": "1790079713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2431 TRADEWIND DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995163402",
            "telephone_number": "305-978-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 DIPLOMACY DR STE 3181",
            "address_2": "SOUTHCENTRAL FOUNDATION",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085925",
            "telephone_number": "907-729-4371",
            "fax_number": "907-729-4135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUISENBERRY",
        "first_name": "KELLY",
        "middle_name": "JOY",
        "name_prefix": "Mrs.",
        "credential": "RD LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-07",
        "last_updated": "2014-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AK",
            "license": "268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1584514",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Registered Dietitian in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; 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.