Provider Demographics
NPI:1538307996
Name:NELLETT, KATHLEEN H
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:H
Last Name:NELLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 BLAIR MILL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1042
Mailing Address - Country:US
Mailing Address - Phone:215-672-0899
Mailing Address - Fax:215-672-5108
Practice Address - Street 1:2729 BLAIR MILL RD
Practice Address - Street 2:SUITE E
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1042
Practice Address - Country:US
Practice Address - Phone:215-672-0899
Practice Address - Fax:215-672-5108
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001137133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered