Most Relevant Information
Provider Data
| NPI Number: | 1003209024 |
| Provider Name: | KELLY HOUSTON RDN, LD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 2013038254 |
Most Important Dates
| Enumeration Date: | 03/16/2015 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
2023 VADALABENE DR STE 200
MARYVILLE
IL
620625636
Practice Location Phone/Fax
| Phone: | 6182887408 |
| Fax: | 6182887418 |
Provider Mailing Location
2023 VADALABENE DR STE 200
MARYVILLE
IL
620625636
Provider Mailing Phone/Fax
| Phone: | 6182887408 |
| Fax: | 6182887418 |