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NPI Code Detail

MEDICARE: KELLY ANNE POOLE M.S.,R.D.

MEDICARE: KELLY ANNE POOLE M.S.,R.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1942353982
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANNE POOLE M.S.,R.D.
Provider Business Mailing Address
First Line : 2261 BIZZONE CIR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-1531
Country : US
Telephone Number : 757-479-6967
Fax Number :
Provider Business Practice Location Address
First Line : 3100 SHORE DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23451-1199
Country : US
Telephone Number : 757-496-1126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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