Individual
AMY LYNN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
254 CLARKSON RD, ELLISVILLE, MO 63011-2245
(636) 227-7337
Mailing address
2523 W CARRIAGE LN, PEORIA, IL 61614-2404
(636) 227-7337
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
164004678
IL
Other
Enumeration date
11/24/2008
Last updated
11/24/2008
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