Provider Demographics
NPI:1518519149
Name:BOYLE, KELLIE LAUREN (MA, RDN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LAUREN
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MA, RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HERON CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9021
Mailing Address - Country:US
Mailing Address - Phone:609-477-0640
Mailing Address - Fax:
Practice Address - Street 1:130 HERON CT
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9021
Practice Address - Country:US
Practice Address - Phone:609-477-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered