Provider Demographics
NPI:1518901164
Name:KELLY, AMY E (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1321 LADY STREET 1ST FLOOR
Mailing Address - Street 2:PALMETTO HEALTH
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:803-296-2525
Practice Address - Street 1:3301 HARDEN STREET 5 MEDICAL PARK
Practice Address - Street 2:PALMETTO HEALTH RICHLAND
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:803-296-2525
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC850077133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered