Individual
KELLI B WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2138 NC HIGHWAY 42 W, CLAYTON, NC 27520-5300
(919) 585-8777
Mailing address
2138 NC HIGHWAY 42 W, CLAYTON, NC 27520-5300
(919) 585-8777
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
004064
NC
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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