Healthcare Provider Details

I. General information

NPI: 1447029855
Provider Name (Legal Business Name): ROSEMARY KELLY RDN/LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 COPELAND HILL RD
HOLDEN ME
04429-7016
US

IV. Provider business mailing address

193 COPELAND HILL RD
HOLDEN ME
04429-7016
US

V. Phone/Fax

Practice location:
  • Phone: 207-385-5701
  • Fax:
Mailing address:
  • Phone: 207-385-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDI267
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: