Provider Demographics
NPI:1447481676
Name:VELOTTA, KELLY R (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:R
Last Name:VELOTTA
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 LINKS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7054
Mailing Address - Country:US
Mailing Address - Phone:919-809-2777
Mailing Address - Fax:
Practice Address - Street 1:1434 LINKS DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7054
Practice Address - Country:US
Practice Address - Phone:919-809-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003158133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered