Active NPI
Kelly Wills, MS, RD
- Registered Dietitian
- Atascadero, CA
National Provider Identifier
1922629385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86063722
- Practice address
- 5955 Capistrano Ave Ste E
Atascadero, CA 93422-7227 - Phone
- (805) 668-3404
- Fax
- (805) 549-5066
- NPI assigned
- Apr 27, 2020
- Reactivated
- Jul 1, 2020
- Sex
- Female
- 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 | 86063722 | CA | Primary |
Addresses
Primary practice location
5955 Capistrano Ave Ste E
Atascadero, CA 93422-7227
Mailing address
5955 Capistrano Ave Ste E
Atascadero, CA 93422-7227
Phone (805) 668-3404
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86063722 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelly Wills Nutrition | Dietitian, Registered | Current | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679356800000",
"number": "1922629385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5955 CAPISTRANO AVE STE E",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934227227",
"telephone_number": "805-668-3404",
"fax_number": "805-549-5066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5955 CAPISTRANO AVE STE E",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934227227",
"telephone_number": "805-668-3404",
"fax_number": "805-549-5066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLS",
"first_name": "KELLY",
"credential": "MS, RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-27",
"last_updated": "2023-03-21",
"certification_date": "2023-03-21",
"deactivation_date": "2020-04-27",
"reactivation_date": "2020-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86063722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atascadero, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.