Individual provider Active NPI

Kelly Michelle Kennelley, RD, LDN

  • Registered Dietitian
  • Erie, PA
National Provider Identifier
1083910012
Registry record updated Feb 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN002326 Issued in PA
Practice address
100 Barber PL
Erie, PA 16507-1863
Phone
(814) 453-7661
Fax
(814) 874-5505
NPI assigned
Feb 9, 2011
Last updated
Feb 9, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DN002326 PA Primary

Addresses

Primary practice location

100 Barber PL
Erie, PA 16507-1863

Mailing address

100 Barber PL
Erie, PA 16507-1863
Phone (814) 453-7661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220504001874 PA Practitioner - Registered Dietitian Or Nutrition Professional 3779970074 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shriners Hospitals for Children CurrentSince Feb 2, 2022 Accepting new patients
Shriners Hospitals for Children Dietitian, Registered CurrentSince Feb 2, 2022 Accepting new patients
Christine Barr PastSince Sep 28, 2021 Accepting new patients
Dr Gertrude a Barber Center Inc PastSince Jul 1, 2004 Accepting new patients

Locations

1645 W 8th St
Erie, PA 16505
Phone (814) 875-8700

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/barberinstitute/r4/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1297209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297209600000",
    "number": "1083910012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BARBER PL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071863",
            "telephone_number": "814-453-7661",
            "fax_number": "814-874-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BARBER PL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071863",
            "telephone_number": "814-453-7661",
            "fax_number": "814-874-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNELLEY",
        "first_name": "KELLY",
        "middle_name": "MICHELLE",
        "credential": "RD, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-09",
        "last_updated": "2011-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN002326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.