Provider Demographics
NPI:1376845172
Name:SCHOOLEY, KELLY SARAH (RD LD/N CLC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SARAH
Last Name:SCHOOLEY
Suffix:
Gender:F
Credentials:RD LD/N CLC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:SARAH
Other - Last Name:CRENSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD/N, CLC
Mailing Address - Street 1:3466 NIGHTSCAPE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1618
Mailing Address - Country:US
Mailing Address - Phone:904-307-9275
Mailing Address - Fax:
Practice Address - Street 1:5322 N PEARL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5119
Practice Address - Country:US
Practice Address - Phone:904-253-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered