Individual
KELSEY BIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7900 STATE ROUTE 163, BELLEVILLE, IL 62223-7744
(618) 980-6545
Mailing address
780 LAKE LUCILLE DR, WATERLOO, IL 62298-3234
(618) 980-6545
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
01/02/2026
Last updated
01/02/2026
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