Provider Demographics
NPI:1457522179
Name:MESSNER, KELLY J (RD, LN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MESSNER
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:HUNTINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LN
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 201
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0414
Practice Address - Country:US
Practice Address - Phone:605-328-8100
Practice Address - Fax:605-328-8101
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered