Provider Demographics
NPI:1902917529
Name:LEONARD, KELLY KAY (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:KAY
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 GLENVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5214
Mailing Address - Country:US
Mailing Address - Phone:720-837-5240
Mailing Address - Fax:
Practice Address - Street 1:303 GLENVIEW CT
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5214
Practice Address - Country:US
Practice Address - Phone:720-837-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO949745133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered