Provider Demographics
NPI:1720332638
Name:NEY, KELLY JEAN (BS,CNC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JEAN
Last Name:NEY
Suffix:
Gender:F
Credentials:BS,CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1833
Mailing Address - Country:US
Mailing Address - Phone:508-358-4900
Mailing Address - Fax:508-358-3525
Practice Address - Street 1:524 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1833
Practice Address - Country:US
Practice Address - Phone:508-358-4900
Practice Address - Fax:508-358-3525
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist