George, Kelly M

George, Kelly M is an individual health care provider with primary practice located at 530 Ne Glen Oak Ave , Peoria IL 61637-0001. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. George, Kelly M can be contacted via phone (309) 655-4600.

Contact Information

Primary practice address
530 Ne Glen Oak Ave Peoria IL 61637-0001
Phone: (309) 655-4600
Fax: (309) 655-4022
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X Illinois

Profile Details

NPI number 1720092281
LBN Legal business name George, Kelly M
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720092281 NPPES
Other 207657 MEDICARE GROUP NO.

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