Provider Demographics
NPI:1780386110
Name:JARNELL, KELSEY (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:JARNELL
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 BAUER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-2024
Mailing Address - Country:US
Mailing Address - Phone:630-301-9769
Mailing Address - Fax:
Practice Address - Street 1:175 E HAWTHORN PKWY STE 325
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1460
Practice Address - Country:US
Practice Address - Phone:224-424-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered