Provider Demographics
NPI:1851685499
Name:ZELLMANN, KELLY JO (RD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:ZELLMANN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 BECIDA RD SW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-9680
Mailing Address - Country:US
Mailing Address - Phone:218-368-4911
Mailing Address - Fax:218-309-5994
Practice Address - Street 1:4691 BECIDA RD SW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-9680
Practice Address - Country:US
Practice Address - Phone:218-368-4911
Practice Address - Fax:218-309-5994
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2181133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400101579Medicare PIN
MNH400101573Medicare PIN