Individual
KELLY LYNNETTE NUCKOLLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS RD
Contact information
Practice address
600 HIGHLAND AVE, MC 2433, MADISON, WI 53792-1530
(608) 662-0817
Mailing address
600 HIGHLAND AVE, MC 2433, MADISON, WI 53792-1530
(608) 662-0817
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
976210
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2219-29
CERTIFIED DIETITIAN
WI
Enumeration date
10/22/2010
Last updated
10/25/2010
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