Healthcare Provider Details

I. General information

NPI: 1972144657
Provider Name (Legal Business Name): REBECCA KELLY MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 LINCOLN SWING UNIT 16
AMES IA
50014-7673
US

IV. Provider business mailing address

4225 LINCOLN SWING UNIT 16
AMES IA
50014-7673
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-6065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number098026
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: