Active NPI
Kelly Marie Neilson, MDA, RD, LD
- Registered Dietitian
- Gardendale, AL
National Provider Identifier
1013568807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2801
- Practice address
- 4496 Sierra LN
Gardendale, AL 35071-4224 - Phone
- (801) 472-4103
- NPI assigned
- Sep 24, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2801 | AL | Primary |
Addresses
Primary practice location
4496 Sierra LN
Gardendale, AL 35071-4224
Mailing address
4496 Sierra LN
Gardendale, AL 35071-4224
Phone (801) 472-4103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Medical Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2801 | AL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569283200000",
"number": "1013568807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4496 SIERRA LN",
"city": "GARDENDALE",
"state": "AL",
"postal_code": "350714224",
"telephone_number": "801-472-4103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4496 SIERRA LN",
"city": "GARDENDALE",
"state": "AL",
"postal_code": "350714224",
"telephone_number": "801-472-4103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEILSON",
"first_name": "KELLY",
"middle_name": "MARIE",
"credential": "MDA, RD, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-24",
"last_updated": "2019-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "AL",
"license": "2801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardendale, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.