| Doctor Name: | KELLY RYAN MALONE |
| NPI Number: | 1619221041 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, RD, LDN |
| License Number: | 979040 |
| Business Practice Address: | 207 Martin Branch Rd Leicester, NC - 287486302 |
| Business Phone Number: | 8282060715 |
| Business Fax Number: | |
| Mailing Address: | 207 Martin Branch Rd, LEICESTER |
| State: | NC |
| Postal Code: | 287486302 |
| Phone Number: | 8282060715 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2012 |
| NPI Last Update Date: | 11/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | 979040 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |