Individual
KELLY M GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
12201 STANFIELD CT, BOWIE, MD 20720-4439
(301) 741-9380
Mailing address
12201 STANFIELD CT, BOWIE, MD 20720-4439
(301) 741-9380
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86109842
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
N/A
—
Enumeration date
06/18/2020
Last updated
06/18/2020
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