Individual
KELLY MARIE NEILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MDA, RD, LD
Contact information
Practice address
4496 SIERRA LN, GARDENDALE, AL 35071-4224
(801) 472-4103
Mailing address
4496 SIERRA LN, GARDENDALE, AL 35071-4224
(801) 472-4103
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2801
AL
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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