Active NPI
Kelly Diamond, RD
- Registered Dietitian
- Charlotte, NC
National Provider Identifier
1063933372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 883192
- Practice address
- 428 E 4TH St
Charlotte, NC 28202-2434 - Phone
- (617) 413-2867
- NPI assigned
- Jun 28, 2017
- 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 | 883192 | Primary |
Addresses
Primary practice location
428 E 4TH St
Charlotte, NC 28202-2434
Mailing address
428 E 4TH St
Charlotte, NC 28202-2434
Other names 1
- Kelly Martray
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascanio Physical Therapy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Cornelius, NC
- NPI 1679148787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498608000000",
"number": "1063933372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "428 E 4TH ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282022434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "428 E 4TH ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282022434",
"telephone_number": "617-413-2867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAMOND",
"first_name": "KELLY",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-28",
"last_updated": "2017-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "883192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "MARTRAY",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.