Provider Demographics
NPI:1801299466
Name:O'NEILL, KELSEY (RD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:CONROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:400 13TH AVE S STE 106
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4300
Mailing Address - Country:US
Mailing Address - Phone:406-455-2841
Mailing Address - Fax:406-455-2842
Practice Address - Street 1:350 HERITAGE WAY STE 1100
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3160
Practice Address - Country:US
Practice Address - Phone:406-752-8900
Practice Address - Fax:406-752-8909
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-34641133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered