Active NPI
Kelly Jean Nelson, RD
- Registered Dietitian
- Kent, WA
National Provider Identifier
1649580184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 00722076
- Practice address
- 6852 S 220TH St
Kent, WA 98032-1963 - Phone
- (253) 872-3460
- Fax
- (888) 599-3448
- NPI assigned
- Oct 18, 2010
- Last updated
- Oct 18, 2010
- 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 | 00722076 | WA | Primary |
Addresses
Primary practice location
6852 S 220TH St
Kent, WA 98032-1963
Mailing address
6852 S 220TH St
Kent, WA 98032-1963
Phone (253) 872-3460
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00722076 | WA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Option 1 Northwest Enteral LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Aveanna Healthcare Medical Solutions
- Parenteral & Enteral Nutrition Supplies (DME)
- Kent, WA
- NPI 1043398407
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1649580184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6852 S 220TH ST",
"city": "KENT",
"state": "WA",
"postal_code": "980321963",
"telephone_number": "253-872-3460",
"fax_number": "888-599-3448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6852 S 220TH ST",
"city": "KENT",
"state": "WA",
"postal_code": "980321963",
"telephone_number": "253-872-3460",
"fax_number": "888-599-3448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "KELLY",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-18",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "00722076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.