Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KEILEY SHAE JOHNSON, RD
Active Sole ProprietorGerontological Nutrition · FARGO, ND
Registration Details
- NPI Number
- 1013781814
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Nov 13, 2023 (2.4387094754066 yrs)
- Last Updated
- Nov 13, 2023
- Licenses
-
1245 (ND)1245 (ND)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2970 BRANDT DR S APT 214FARGO, ND, 581049078Browse ND providers · Browse ZIP 58104
- Phone
- 7012126207
- Primary Specialty
-
Gerontological Nutrition
133VN1101X
- Additional Specialty
- Gerontological Nutrition
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.