Individual
KELLY LYNN TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 983-6353
Mailing address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 983-6353
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
2008002033
MO
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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