Provider Demographics
NPI:1639592629
Name:BERRY, KELLIE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COURTHOUSE LN UNIT 10
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1723
Mailing Address - Country:US
Mailing Address - Phone:978-408-8812
Mailing Address - Fax:
Practice Address - Street 1:2 COURTHOUSE LN UNIT 10
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1723
Practice Address - Country:US
Practice Address - Phone:978-408-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3216133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered