Provider Demographics
NPI:1407522477
Name:MILLAN, KELLY DAIGLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAIGLE
Last Name:MILLAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:DAIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:14 BIRCHMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-5503
Mailing Address - Country:US
Mailing Address - Phone:978-879-9374
Mailing Address - Fax:
Practice Address - Street 1:14 BIRCHMEADOW RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-5503
Practice Address - Country:US
Practice Address - Phone:978-879-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86154755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered