Individual
KELLY SUE LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NUTRITIONIST
Contact information
Practice address
2801 BLUE RIDGE RD, RALEIGH, NC 27607-0114
(984) 974-0502
(984) 974-9579
Mailing address
2801 BLUE RIDGE RD, RALEIGH, NC 27607-0114
(984) 974-0502
(984) 974-9579
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
969608
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004909976
—
VA
Enumeration date
01/26/2011
Last updated
04/04/2025
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