Provider Demographics
NPI:1275532681
Name:KELLEY, BETH ANN (RD, CD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RD, CD, CDE
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:WEETMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD, CDE
Mailing Address - Street 1:331 SADLER COVE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-3811
Mailing Address - Country:US
Mailing Address - Phone:912-552-1478
Mailing Address - Fax:
Practice Address - Street 1:331 SADLER COVE DR
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-3811
Practice Address - Country:US
Practice Address - Phone:912-552-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN833022133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered