Individual
KELLY C O'HERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD CD
Contact information
Practice address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
Mailing address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1939
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490905189007
ANTHEM BC/BS
WI
Enumeration date
07/26/2006
Last updated
03/03/2025
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