Kelly Nutrition, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KELLY NUTRITION, LLC

Practice address

100 Executive Dr Ste F
Lafayette, IN 47905-4864

Phone

(765) 413-5609

NPI assigned

Feb 6, 2024

Last updated

May 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly VandameNPI 1194319798

Title

Owner

Phone

(765) 413-5609

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly S. Vandame

  • Registered Dietitian
  • Lafayette, IN
  • NPI 1194319798
  NPD Authorized official

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1033972518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5134 FLORENCE LN",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479057741",
            "telephone_number": "765-413-5609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EXECUTIVE DR STE F",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054864",
            "telephone_number": "765-413-5609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "VANDAME",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-413-5609"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Keirns, RBT
• Megan Keller
• Philip E Keller, MD
• David W Kelley, D.O.
• Jack Leslie Kelley, MD
• Bryan Kelly
• Christi Gay Kelly, RN
• Dean M Kelly, ANP
• Katherine Joann Kelly, NP
• Lindsey Rae Kemper, PHARMD

• Clinic/Center in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.