Provider Demographics
NPI:1366040313
Name:MAGILL, KELLEY SHANNON (MS, RD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:SHANNON
Last Name:MAGILL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N QUIDNESSETT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1044
Mailing Address - Country:US
Mailing Address - Phone:401-626-1380
Mailing Address - Fax:
Practice Address - Street 1:730 N QUIDNESSETT RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-1044
Practice Address - Country:US
Practice Address - Phone:401-626-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered