| Kelly Nutrition, Llc | |
|
100 Executive Dr Ste F Lafayette IN 47905-4864 | |
| (765) 413-5609 | |
| Not Available |
| Full Name | Kelly Nutrition, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 100 Executive Dr Ste F, Lafayette, Indiana |
| Authorized Official Name and Position | Kelly Vandame (OWNER) |
| Authorized Official Contact | 7654135609 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Nutrition, Llc 5134 Florence Ln Lafayette IN 47905-7741 Ph: (765) 413-5609 | Kelly Nutrition, Llc 100 Executive Dr Ste F Lafayette IN 47905-4864 Ph: (765) 413-5609 |
| NPI Number | 1033972518 |
|---|---|
| Provider Enumeration Date | 02/06/2024 |
| Last Update Date | 05/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033972518 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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