Provider Demographics
NPI:1104668490
Name:MULLANEY, KAYCEE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KAYCEE
Middle Name:
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 AUDUBON PL APT 1314
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7139
Mailing Address - Country:US
Mailing Address - Phone:502-599-2176
Mailing Address - Fax:
Practice Address - Street 1:100 AUDUBON PL APT 1314
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7139
Practice Address - Country:US
Practice Address - Phone:502-599-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6109133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered