Provider Demographics
NPI:1376187773
Name:OCONNELL, KELLI ELIZABETH (MS RD LDN)
Entity Type:Individual
Prefix:MISS
First Name:KELLI
Middle Name:ELIZABETH
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FIELDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-4254
Mailing Address - Country:US
Mailing Address - Phone:610-401-7649
Mailing Address - Fax:
Practice Address - Street 1:55 FIELDSTONE LN
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-4254
Practice Address - Country:US
Practice Address - Phone:610-401-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered