Kelly, Mary Ann
Kelly, Mary Ann is an individual health care provider with primary practice located at 1000 E Mountain Blvd , Wilkes Barre PA 18711-0027. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Kelly, Mary Ann can be contacted via phone (570) 808-7803.Contact Information
Primary practice address
1000 E Mountain Blvd
Wilkes Barre PA 18711-0027
Phone: (570) 808-7803
Fax: (570) 808-3230
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dietary & Nutritional Service Providers / Dietitian, Registered | 133V00000X | 816228 | New York |
| Dietary & Nutritional Service Providers / Dietitian, Registered | 133V00000X | ||
| Dietary & Nutritional Service Providers / Dietitian, Registered | 133V00000X | DN000257 | Pennsylvania |
Profile Details
| NPI number | 1346340445 |
|---|---|
| LBN Legal business name | Kelly, Mary Ann |
| Credentials | Registered Dietitian (RD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2006 |
| Last updated | Oct 18th, 2021 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346340445 | NPPES |
| New York | MEDICAID | 1346340445 | |
| New York | Other | 1346340445 |
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