Provider Demographics
NPI:1457773707
Name:JONES, KELLY R (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CAMBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3323
Mailing Address - Country:US
Mailing Address - Phone:203-556-9337
Mailing Address - Fax:
Practice Address - Street 1:265 CAMBRIDGE LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3323
Practice Address - Country:US
Practice Address - Phone:203-556-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004380133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered