NPI 1417643149 · live from the CMS NPI Registry
Keely Bourassa, RD
Dietitian, Registered in Terre Haute, IN. National Provider Identifier 1417643149, active.
NPI record
| NPI | 1417643149 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 1200 S Center St, Terre Haute, IN 47802 |
| Practice phone | 317-753-7308 |
| Enumerated | April 14, 2023 |
| Last updated | April 21, 2023 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 37003359A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.