Provider Demographics
NPI:1184174625
Name:OGDEN, KELLY (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:OGDEN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3321
Mailing Address - Country:US
Mailing Address - Phone:518-421-9852
Mailing Address - Fax:
Practice Address - Street 1:260 WASHINGTON AVENUE EXT
Practice Address - Street 2:101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6326
Practice Address - Country:US
Practice Address - Phone:518-218-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008642133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered