Provider Demographics
NPI:1447620042
Name:LITERSKY, KELLY A (MS, RD, CD)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:LITERSKY
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:SAMZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:5000 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-3900
Mailing Address - Country:US
Mailing Address - Phone:920-794-5114
Mailing Address - Fax:920-794-5492
Practice Address - Street 1:5000 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3900
Practice Address - Country:US
Practice Address - Phone:920-794-5114
Practice Address - Fax:920-794-5492
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI968887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered