Laura Jean Kelly, RD, CSO, CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

956635 Issued in NY

Practice address

650 Commack Rd
Commack, NY 11725-5404

Phone

(631) 623-4000

Fax

(631) 864-2787

NPI assigned

Jun 22, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1013203702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 COMMACK RD",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117255404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 COMMACK RD",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117255404",
            "telephone_number": "631-623-4000",
            "fax_number": "631-864-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LAURA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "RD, CSO, CDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NY",
            "license": "7184206",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "956635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• KB Massage Therapy P.C.
• Maria Keating-Padberg, LCSW
• Joanna Keegan
• Colleen Kelly, P.A.
• Dejon Paul Kelly
• Maureen Jeanette Kelly, P.A.
• Stephen Patrick Kelly, COTA
• Andrea Michelle Keltos, LMSW
• Bethany H Kennedy, ANP, MSN, RN
• Gregory Wayne Kennedy, DDS

• Registered Dietitian in Commack, NY
• Providers in Commack, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.