Provider Demographics
NPI:1104368877
Name:MCMORDIE, KALEIGH (MCN, RDN, LD)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:MCMORDIE
Suffix:
Gender:F
Credentials:MCN, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 98TH ST
Mailing Address - Street 2:STE 4-365
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-3847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3410 98TH ST
Practice Address - Street 2:STE 4-365
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-3847
Practice Address - Country:US
Practice Address - Phone:682-622-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered