| NPI | 1588268429 |
|---|---|
| Former Name | KELLY JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX 86041805) |
| Additional Taxonomies | 133VN1301X Dietitian, Registered, Nutrition, Oncology |
| Enumeration Date | 2020-11-22 |
| Last Update Date | 2020-11-22 |