Kelly Pendleton, RD

Primary specialty

Renal Nutrition Registered DietitianTaxonomy code 133VN1005X

License

945221 Issued in AL

Practice address

592 Fieldstown Rd
Ste. 102 - CKD Services of Gardendale
Gardendale, AL 35071-3414

Phone

(205) 608-3653

Fax

(205) 608-3654

NPI assigned

Feb 5, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Stephens Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202169600000",
    "number": "1750569539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 KYLE CT",
            "city": "GARDENDALE",
            "state": "AL",
            "postal_code": "350712716",
            "telephone_number": "678-764-3940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "592 FIELDSTOWN RD",
            "address_2": "STE. 102 - CKD SERVICES OF GARDENDALE",
            "city": "GARDENDALE",
            "state": "AL",
            "postal_code": "350713414",
            "telephone_number": "205-608-3653",
            "fax_number": "205-608-3654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDLETON",
        "first_name": "KELLY",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-05",
        "last_updated": "2008-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "AL",
            "license": "945221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "STEPHENS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Renal Nutrition Registered Dietitian in Gardendale, AL
• Providers in Gardendale, AL by specialty
• Renal Nutrition Registered Dietitian in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; 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.