Provider Demographics
NPI:1245560622
Name:BAUMBERGER, KELLY ANN (RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:BAUMBERGER
Suffix:
Gender:F
Credentials:RD,LDN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:NUTRITION AND FOOD SERVICES DEPARTMENT
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-966-0833
Mailing Address - Fax:919-966-3217
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:NUTRITION AND FOOD SERVICES DEPARTMENT
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-0833
Practice Address - Fax:919-966-3217
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003355133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered