Provider Demographics
NPI:1831673771
Name:CORRIGAN, KELLY (RDN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SE MAIN ST STE 316
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2470
Mailing Address - Country:US
Mailing Address - Phone:503-256-1575
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 316
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2470
Practice Address - Country:US
Practice Address - Phone:503-256-1575
Practice Address - Fax:503-253-9848
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86075764133V00000X
OR10234940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered