Provider Demographics
NPI:1881832533
Name:KELLEY, REBECCA LANELL (RD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LANELL
Last Name:KELLEY
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 1:1001 TRUE ST
Mailing Address - Street 2:APT 613
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1746
Mailing Address - Country:US
Mailing Address - Phone:318-613-8491
Mailing Address - Fax:
Practice Address - Street 1:1001 TRUE ST
Practice Address - Street 2:APT 613
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1746
Practice Address - Country:US
Practice Address - Phone:318-613-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered