Provider Demographics
NPI:1568853471
Name:KELLY, BETH ANN (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9641
Mailing Address - Country:US
Mailing Address - Phone:215-933-0069
Mailing Address - Fax:215-933-3672
Practice Address - Street 1:847 EASTON RD STE 2800
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2908
Practice Address - Country:US
Practice Address - Phone:215-710-2058
Practice Address - Fax:215-710-6465
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005588133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered