Provider Demographics
NPI:1770525750
Name:INMAN, KELLY (RD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:INMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 S 2ND ST
Practice Address - Street 2:SUITE 3F
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1612
Practice Address - Country:US
Practice Address - Phone:717-230-3459
Practice Address - Fax:717-230-3411
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN002116OtherLICENSE