Provider Demographics
NPI:1124905591
Name:IVES, KELSIE LYNN (MBA, MS, RD)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:LYNN
Last Name:IVES
Suffix:
Gender:F
Credentials:MBA, MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7689 BIERSTADT HTS
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6114
Mailing Address - Country:US
Mailing Address - Phone:817-965-4580
Mailing Address - Fax:
Practice Address - Street 1:7689 BIERSTADT HTS
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-6114
Practice Address - Country:US
Practice Address - Phone:817-965-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered