Provider Demographics
NPI:1295094662
Name:MARSHALL, KELLY MARIE (MS, RD, CDCES, EP-C)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, RD, CDCES, EP-C
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CDE, HFS
Mailing Address - Street 1:1001 BISHOP ST STE 2685A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3404
Mailing Address - Country:US
Mailing Address - Phone:808-551-5302
Mailing Address - Fax:808-490-0372
Practice Address - Street 1:1001 BISHOP ST STE 2685A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3404
Practice Address - Country:US
Practice Address - Phone:808-551-5302
Practice Address - Fax:808-490-0372
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1062291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered