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Individual
KELLI FREDERICK
Active
Individual
KELLI FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI00001335
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8293979
PROVIDER NUMBER
WA
01
—
887397
ADA NUMBER
WA
05
—
9051731
—
WA
01
—
DI00001335
WA CERTIFICATION NUMBER
WA
Enumeration date
05/28/2008
Last updated
05/28/2008
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