Amy Lynn Kelly, RD

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

164004678 Issued in IL

Practice address

254 Clarkson Rd
Ellisville, MO 63011-2245

Phone

(636) 227-7337

NPI assigned

Nov 24, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Education Dietitian Services

  • Home Health Agency
  • Ellisville, MO
  • NPI 1598862724
  NPD (past)

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

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227484800000",
    "number": "1811142433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2523 W CARRIAGE LN",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142404",
            "telephone_number": "636-227-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 CLARKSON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112245",
            "telephone_number": "636-227-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-24",
        "last_updated": "2008-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "IL",
            "license": "164004678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• K&S Medical, L.L.C.
• Jennifer Christine Kane, D.C.
• Kathryn Schormann LLC (Monarch-therapies)
• Aya Kaziz
• Rachel I Kehr, DDS
• Matthew Spencer Kelly, OD
• David Mark Keune, CRNFA
• Mary Richel Kimbrough, DPT
• Megan Klimkewicz, MS
• Jennifer Klinger, O.D.

• Pediatric Nutrition Registered Dietitian in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Pediatric Nutrition Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 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.