Individual
KELLY MARYANN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-5000
(731) 660-8739
Mailing address
PO BOX 3788, JACKSON, TN 38303-3788
(731) 660-8730
(731) 660-8739
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2339
TN
Other
Enumeration date
10/07/2011
Last updated
10/07/2011
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