Sandra Lynn Kelly, DTR

Primary specialty

Registered Dietetic TechnicianTaxonomy code 136A00000X

License

975125 Issued in TN

Practice address

262 Danny Thomas PL
Memphis, TN 38105-3678

Phone

(901) 595-0499

Fax

(901) 595-3202

NPI assigned

Mar 8, 2022

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

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": "1646697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1750038865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 DANNY THOMAS PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381053678",
            "telephone_number": "901-595-0499",
            "fax_number": "901-595-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 DANNY THOMAS PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381053678",
            "telephone_number": "901-595-0499",
            "fax_number": "901-595-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SANDRA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "DTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-08",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": "TN",
            "license": "975125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah G Kelly, DPH
• Deborah Lynn Kelly, LCSW
• Hallie R Kelly, NP
• Jayna Kelly, MD
• Linda Faye Kelly, FNP
• Willie Faye Kelly, NP
• Haley Kelso, BCBA
• Kacie Jay Kelso
• Goodloe Malone Keltner Jr., D.D.S.
• Kem'S House Inc.

• Registered Dietetic Technician in Memphis, TN
• Providers in Memphis, TN by specialty
• Registered Dietetic Technician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.