Individual
KELLY CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
10401 W THUNDERBIRD BLVD, SUN CITY, AZ 85351-3004
(623) 876-5455
(623) 876-6687
Mailing address
PO BOX 53568, SUN HEALTH CLINICS BUSINESS OFFICE, PHOENIX, AZ 85072
(623) 544-5075
(623) 544-5093
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
863763
—
AZ
Enumeration date
08/25/2005
Last updated
05/05/2008
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