Individual ProviderKelly Kathleen GibbonsDietitian, RegisteredDietary & Nutritional Service ProvidersPractice Address102 Irving St NW, Food And Nutrition Department, Washington, DC 20010-2921(202) 877-1043PECOS EnrollmentBased on the most recent information from CMS, provider Kelly Kathleen Gibbons does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1992953624Provider TypeIndividualFull NameGibbons, Kelly KathleenTitleMs.CredentialMS, RD, LDGenderFemaleSole ProprietorNoEnumeration Date9/6/2008Last Updated9/6/2008Contact InformationPractice LocationPractice Address102 Irving St NW, Food And Nutrition Department, Washington, DC 20010-2921Phone(202) 877-1043Fax(202) 723-3816Mailing LocationMailing Address102 Irving St NW, Food And Nutrition Department, Washington, DC 20010-2921Phone(202) 877-1043Fax(202) 723-3816Provider TaxonomiesCodeDescriptionLicenseCode133V00000XPrimaryDescriptionDietitian, RegisteredDietary & Nutritional Service ProvidersLicenseDI100000265District of Columbia