Organization
FUEL YOUR INTENSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY ROZIER RD, LD (REGISTERED DIETITIAN)
(972) 935-6722
Entity
Organization
Contact information
Practice address
209 E MAIN ST, WAXAHACHIE, TX 75165-3755
(469) 383-8334
Mailing address
209 E MAIN ST, WAXAHACHIE, TX 75165-3755
(469) 383-8334
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT07454
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1531043
CIGNA
TX
05
—
196126001
—
TX
Enumeration date
03/07/2014
Last updated
04/01/2014
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