Provider Demographics
NPI:1295816981
Name:BERGIVEN, KELLY A (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:BERGIVEN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:NOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1119 TABOR TER
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-1428
Mailing Address - Country:US
Mailing Address - Phone:215-722-6435
Mailing Address - Fax:
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1219
Practice Address - Country:US
Practice Address - Phone:215-710-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000155133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered