Active NPI
Michael Ann Kelly, M.S., R.D., L.D.N.
- Registered Dietitian
- Dekalb, IL
National Provider Identifier
1083054993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.005938
- Practice address
- 1 Kish Hospital Dr
Dekalb, IL 60115-9602 - Phone
- (815) 756-1521
- NPI assigned
- Jun 25, 2013
- Sex
- Female
- Sole proprietor
- No
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 | 164.005938 | IL | Primary |
Addresses
Primary practice location
1 Kish Hospital Dr
Dekalb, IL 60115-9602
Mailing address
205 W South St
Dwight, IL 60420-1238
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.005938 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1083054993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 W SOUTH ST",
"city": "DWIGHT",
"state": "IL",
"postal_code": "604201238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KISH HOSPITAL DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159602",
"telephone_number": "815-756-1521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MICHAEL",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "M.S., R.D., L.D.N.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-25",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.005938",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.