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 10 years ago.

NPI1003001405 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameMS. KELLY L DEVINE MS, RD, LDN
Provider Location Address6840 W WINDING TRL UNIT 401 OAK FOREST, IL 60452 Additional informationCallout TooltipProvider 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 Address6840 W WINDING TRL UNIT 401 OAK FOREST, IL 60452 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderFemale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity 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 Additional informationCallout TooltipWhat 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 Date09-09-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date01-25-2008 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

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

Primary Taxonomy

Taxonomy Code133V00000X Additional informationCallout TooltipPrimary 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.
ClassificationDietitian, Registered
TypeDietary & Nutritional Service Providers
License StateIL
Taxonomy DescriptionA 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.

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
K47013/204133MEDICARE PIN (08)IL

Map Location


MS. KELLY L DEVINE MS, RD, LDN address is 6840 W WINDING TRL UNIT 401 OAK FOREST, IL 60452