Provider Demographics
NPI:1194957449
Name:KEALEY, JODY J (RD, LD)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:J
Last Name:KEALEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E RUSHOLME ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2452
Mailing Address - Country:US
Mailing Address - Phone:563-421-3035
Mailing Address - Fax:563-421-3039
Practice Address - Street 1:1230 E RUSHOLME ST
Practice Address - Street 2:SUITE 305
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2452
Practice Address - Country:US
Practice Address - Phone:563-421-3035
Practice Address - Fax:563-421-3039
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01011133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered