Individual
KELLEY KAY KULL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12178 BOREHAM MINE RD, GRASS VALLEY, CA 95945-9322
(530) 386-4098
Mailing address
12178 BOREHAM MINE RD, GRASS VALLEY, CA 95945-9322
(530) 386-4098
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
727521
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659361392
—
CA
Enumeration date
09/18/2017
Last updated
07/21/2022
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