MS. KELLY L DEVINE MS, RD, LDN NPI 1003001405

Dietitian, Registered in Oak Forest, IL

About KELLY DEVINE

Kelly Devine is a provider in Oak Forest, IL. The NPI number assigned to this provider is 1003001405. The practitioner's primary taxonomy code is Dietitian, Registered (133V00000X). The provider is registered as an individual and their NPI record was last updated 11 years ago.

NPI	1003001405 National Provider Indentifier (NPI) The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name	MS. KELLY L DEVINE MS, RD, LDN
Provider Location Address	6840 W WINDING TRL UNIT 401 OAK FOREST, IL 60452 Provider location address The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address	6840 W WINDING TRL UNIT 401 OAK FOREST, IL 60452 Provider mailing address The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Gender	Female
NPI Entity Type	Individual Entity type code The code describing the type of health care provider that is being assigned an NPI. Codes are: 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?	Yes
Is Organization Subpart?	N/A What is a subpart? Subparts are the components and separate physical locations of organization health care providers. Examples include: Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date	09-09-2007 Provider enumeration date The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date	01-25-2008 Last update date The date that a record was last updated or changed.

Primary Taxonomy

Taxonomy Code	133V00000X Primary Taxonomy Code The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Classification	Dietitian, Registered
Type	Dietary & Nutritional Service Providers
License State	IL
Taxonomy Description	A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration.

Business Address

MS. KELLY L DEVINE MS, RD, LDN
6840 W WINDING TRL UNIT 401
OAK FOREST, IL
ZIP 60452
Phone: (708) 612-0876

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Mailing Address

MS. KELLY L DEVINE MS, RD, LDN
6840 W WINDING TRL UNIT 401
OAK FOREST, IL
ZIP 60452
Phone: (708) 612-0876

Additional Identifiers

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State
K47013/204133	MEDICARE PIN (08)	IL

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