Kelley Kay Kull

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

727521 Issued in CA

Practice address

12178 Boreham Mine Rd
Grass Valley, CA 95945-9322

Phone

(530) 386-4098

NPI assigned

Sep 18, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508385873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12178 BOREHAM MINE RD",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959459322",
            "telephone_number": "530-386-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12178 BOREHAM MINE RD",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959459322",
            "telephone_number": "530-386-4098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Glasson Way",
            "address_purpose": "LOCATION",
            "city": "Grass Valley",
            "state": "CA",
            "postal_code": "959455723",
            "country_code": "US",
            "telephone_number": "530-274-6676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KULL",
        "first_name": "KELLEY",
        "middle_name": "KAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "727521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659361392",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Presley Angelica Kennedy Lee Krutiak
• Sharal Marlena Krzyzopolski, SUDCC
• Michelle Kucera, DDS
• Kuldip Gill M D P C
• Ganesh Arun Kulkarni, M.D;
• Joel Kyne, CADC-II
• Stacie La Jeunesse, CPNP
• Gyspy S La'More
• John Walter Lace, M.D., F.C.C.P.
• Catari Lacorazza

• Registered Dietitian in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.