Provider Demographics
NPI:1609635119
Name:SNOW, KELLY WATERS (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:WATERS
Last Name:SNOW
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 OLD BRYAN DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5801
Mailing Address - Country:US
Mailing Address - Phone:843-855-3009
Mailing Address - Fax:
Practice Address - Street 1:2841 OLD BRYAN DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5801
Practice Address - Country:US
Practice Address - Phone:843-855-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered