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General NPI Number Information
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NPI Number | 1891757084
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Entity Type | Individual
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Provider Name | KELLI J. KIDD M.S., R.D., LDN
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Gender | Female
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 11 FRIENDSHIP ST
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City | NEWPORT
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State | RI
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Zip | 02840-2209
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Country | US
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Telephone | 401-845-1254
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Fax |
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Provider Business Mailing Address
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Address Line | 900 WASHINGTON ROAD CREDENTENTIAL'S OFFICE, KELLER ARMY COMMUNITY HOSPITAL
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City | WEST POINT
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State | NY
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Zip | 10996-1197
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Country | US
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Telephone | 845-446-6546
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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 | 005328
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LDN00763
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License Number State | RI
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