Healthcare Provider Details

I. General information

NPI: 1073778189
Provider Name (Legal Business Name): KELLY J. NELSON MS RD CSO LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 STATE ROUTE 89
ASHLAND OH
44805-9763
US

IV. Provider business mailing address

1407 STATE ROUTE 89
ASHLAND OH
44805-9763
US

V. Phone/Fax

Practice location:
  • Phone: 937-269-5397
  • Fax:
Mailing address:
  • Phone: 937-269-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3331
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: