Kelly Lynne Davis, RD, CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

006973-1 Issued in NY

Practice address

1824 State Route 80
New Woodstock, NY 13122-9715

Phone

(315) 256-8136

NPI assigned

Aug 11, 2010

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

Enrolled in NY

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nysarc Inc.Group PAC ID 6608869193, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Nysarc Inc.

  dba The Arc Madison Cortland

  • Clinic/Center
  • Oneida, NY
  • NPI 1427113547
  Medicare reassignment Care Compare group NPD
• Madison Cortland Chapter, Nysarc, Inc

  • Early Intervention Provider Agency
  • Oneida, NY
  • NPI 1336454586
  NPD (past)

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1932414240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 STATE ROUTE 80",
            "city": "NEW WOODSTOCK",
            "state": "NY",
            "postal_code": "131229715",
            "telephone_number": "315-256-8136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 STATE ROUTE 80",
            "city": "NEW WOODSTOCK",
            "state": "NY",
            "postal_code": "131229715",
            "telephone_number": "315-256-8136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KELLY",
        "middle_name": "LYNNE",
        "credential": "RD, CDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-11",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "006973-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia L Hirt
• Elizabeth Ann Liddell, LMHC
• Merlin Naomi Marrain, HEALTH EDUCATOR, CLC
• Nichele Lynne Marshall, M.S.,TSHH
• Desiree L Palmer, R.N.

• Registered Dietitian in New Woodstock, NY
• Providers in New Woodstock, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.