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NPI Code Detail

MEDICARE: KATHRYN KELLY MS, LDN, RD, CDE

MEDICARE: KATHRYN KELLY MS, LDN, RD, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian404MA

General Provider Information

NPI Number : 1376777375
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN KELLY MS, LDN, RD, CDE
Provider Business Mailing Address
First Line : 19 SAMUEL WOODWORTH RD
Second Line :
City : NORWELL
State : MA
Zip : 02061-1322
Country : US
Telephone Number : 781-424-8382
Fax Number :
Provider Business Practice Location Address
First Line : 1221 MAIN ST
Second Line : SUITE 203
City : SOUTH WEYMOUTH
State : MA
Zip : 02190-1561
Country : US
Telephone Number : 781-335-7559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2009
Last Update Date : 06/06/2014

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