Provider Demographics
NPI:1003092123
Name:KELNER, LESLEY GAIL (RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:GAIL
Last Name:KELNER
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:MISS
Other - First Name:LESLEY
Other - Middle Name:GAIL
Other - Last Name:MUSSELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8228
Mailing Address - Country:US
Mailing Address - Phone:215-741-4680
Mailing Address - Fax:215-741-4683
Practice Address - Street 1:2346 TRENTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1423
Practice Address - Country:US
Practice Address - Phone:215-741-4680
Practice Address - Fax:215-741-4683
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000589133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered