Individual
KEILEY SHAE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2970 BRANDT DR S APT 214, FARGO, ND 58104-9078
(701) 212-6207
Mailing address
2970 BRANDT DR S APT 214, FARGO, ND 58104-9078
(701) 212-6207
Taxonomy
Speciality
Code
Description
License number
State
133VN1101X
Gerontological Nutrition Registered Dietitian
Primary
1245
ND
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
1245
ND
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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