Provider Demographics
NPI:1083448534
Name:HARRIS, KAYDEE MAE (RDN)
Entity type:Individual
Prefix:
First Name:KAYDEE
Middle Name:MAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KAYDEE
Other - Middle Name:MAE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:160 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-9543
Mailing Address - Country:US
Mailing Address - Phone:360-560-9760
Mailing Address - Fax:
Practice Address - Street 1:160 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-9543
Practice Address - Country:US
Practice Address - Phone:360-560-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered