Healthcare Provider Details

I. General information

NPI: 1073431045
Provider Name (Legal Business Name): LAURA KELLY NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 GOSHEFF LN
GAMBRILLS MD
21054-1936
US

IV. Provider business mailing address

3131 GOSHEFF LN
GAMBRILLS MD
21054-1936
US

V. Phone/Fax

Practice location:
  • Phone: 410-991-4420
  • Fax: 410-541-4342
Mailing address:
  • Phone: 410-991-4420
  • Fax: 410-541-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA ANNE GOLDBLATT KELLY
Title or Position: OWNER
Credential: LDN, CNS
Phone: 410-991-4420