1689677569 NPI number — KEELEY C DROTZ RDN (REGISTERED DIET

Table of content: KEELEY C DROTZ RDN (REGISTERED DIET (NPI 1689677569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689677569 NPI number — KEELEY C DROTZ RDN (REGISTERED DIET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DROTZ
Provider First Name:
KEELEY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN (REGISTERED DIET
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAVENDER
Provider Other First Name:
KEELEY
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689677569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5913 WATERFORD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75071-8034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-678-2154
Provider Business Mailing Address Fax Number:
253-435-7569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5531 VIRGINIA PARKWAY, SUITE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75071-8034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-678-2154
Provider Business Practice Location Address Fax Number:
253-435-7569
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  DI00001453 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: DT83586 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)