Individual
KRISTA FAIRCLOTH KELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LDN
Contact information
Practice address
2504 PRAIRIE HILL DR, ANTIOCH, TN 37013-3682
(912) 294-7630
Mailing address
2504 PRAIRIE HILL DR, ANTIOCH, TN 37013-3682
(912) 294-7630
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDN0000003477
TN
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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