Provider Demographics
NPI:1457805897
Name:O'KELLEY, CARRIE A (RD, LDN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:O'KELLEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 MILITARY CUTOFF RD
Mailing Address - Street 2:#200
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3637
Mailing Address - Country:US
Mailing Address - Phone:910-300-9401
Mailing Address - Fax:
Practice Address - Street 1:1437 MILITARY CUTOFF RD
Practice Address - Street 2:#200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3637
Practice Address - Country:US
Practice Address - Phone:910-300-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered