Organization
KELLY NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY VANDAME (OWNER)
(765) 413-5609
Entity
Organization
Contact information
Practice address
100 EXECUTIVE DR STE F, LAFAYETTE, IN 47905-4864
(765) 413-5609
Mailing address
5134 FLORENCE LN, LAFAYETTE, IN 47905-7741
(765) 413-5609
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/06/2024
Last updated
05/28/2024
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