Active NPI
Nathaniel Sherwood Kelly, R.D.
- Registered Dietitian
- Kernersville, NC
National Provider Identifier
1649546516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L003950
- Practice address
- 420 W Mountain St
Kernersville, NC 27284-2534 - Phone
- (338) 993-1618
- NPI assigned
- Mar 26, 2012
- Sex
- Male
- 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 | L003950 | NC | Primary |
Addresses
Primary practice location
420 W Mountain St
Kernersville, NC 27284-2534
Mailing address
1114 Valley Park Dr
Chapel Hill, NC 27514-3325
Phone (919) 636-2793
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 1, 2016 through Sep 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L003950 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332720000000",
"number": "1649546516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1114 VALLEY PARK DR",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275143325",
"telephone_number": "919-636-2793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W MOUNTAIN ST",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272842534",
"telephone_number": "338-993-1618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "NATHANIEL",
"middle_name": "SHERWOOD",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-26",
"last_updated": "2012-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L003950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.