Individual
MRS. KELLI DOMINICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., LD, RD, CDE
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
1270
LA
133N00000X
Nutritionist
DT05308
TX
133NN1002X
Nutrition Education Nutritionist
1270
LA
133NN1002X
Nutrition Education Nutritionist
DT05308
TX
133V00000X
Registered Dietitian
1270
LA
133V00000X
Registered Dietitian
Primary
DT05308
TX
133VN1004X
Pediatric Nutrition Registered Dietitian
1270
LA
133VN1004X
Pediatric Nutrition Registered Dietitian
DT05308
TX
133VN1005X
Renal Nutrition Registered Dietitian
1270
LA
133VN1005X
Renal Nutrition Registered Dietitian
DT05308
TX
133VN1006X
Metabolic Nutrition Registered Dietitian
1270
LA
133VN1006X
Metabolic Nutrition Registered Dietitian
DT05308
TX
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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