Provider Demographics
NPI:1568219913
Name:HEALY, KELSEY (BS DPD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HEALY
Suffix:
Gender:F
Credentials:BS DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PITNEY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2933
Mailing Address - Country:US
Mailing Address - Phone:732-492-6007
Mailing Address - Fax:
Practice Address - Street 1:15 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1409
Practice Address - Country:US
Practice Address - Phone:732-813-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education