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General NPI Number Information
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NPI Number | 1750744488
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Entity Type | Individual
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Provider Name | JENNA KELLEY MS, RD, CD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 4800 SAND POINT WAY NE
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City | SEATTLE
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State | WA
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Zip | 98105-3901
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Country | US
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Telephone | 206-987-8827
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Fax |
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Provider Business Mailing Address
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Address Line | 819 VIRGINIA ST UNIT 2504
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City | SEATTLE
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State | WA
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Zip | 98101-4429
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Country | US
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Telephone | 262-951-8443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 4048
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 4048
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License Number State | MA
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