Provider Demographics
NPI:1447029855
Name:KELLY, ROSEMARY (RDN/LDN)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 COPELAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-7016
Mailing Address - Country:US
Mailing Address - Phone:207-385-5701
Mailing Address - Fax:
Practice Address - Street 1:193 COPELAND HILL RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:ME
Practice Address - Zip Code:04429-7016
Practice Address - Country:US
Practice Address - Phone:207-385-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI267133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education