Healthcare Provider Details

I. General information

NPI: 1295131142
Provider Name (Legal Business Name): KELLY MARIE SCHMIDT R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KELLY MARIE HAMILTON

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 LOCUST AVE
FAIRMONT WV
26554-1435
US

IV. Provider business mailing address

157 INDEPENDENCE HILLS VLG
MORGANTOWN WV
26505-2546
US

V. Phone/Fax

Practice location:
  • Phone: 304-367-7100
  • Fax:
Mailing address:
  • Phone: 304-619-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number972
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: