Individual
KELLY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LD, CSO
Contact information
Practice address
1242 DEMARET LN, HOUSTON, TX 77055-6136
(254) 493-5962
Mailing address
1242 DEMARET LN, HOUSTON, TX 77055-6136
(254) 493-5962
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86041805
TX
133VN1301X
Oncology Nutrition Registered Dietitian
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Other
Enumeration date
11/22/2020
Last updated
11/22/2020
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