Provider Demographics
NPI:1528126729
Name:CORCORAN, KAY ELIZABETH (RD, LD)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:ELIZABETH
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:ELIZABETH
Other - Last Name:MCKINNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:9040A JACKSON AVENUE
Mailing Address - Street 2:NUTRITION CARE DIVISION
Mailing Address - City:JBLM
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:253-968-0549
Mailing Address - Fax:573-596-0524
Practice Address - Street 1:9040A JACKSON AVENUE
Practice Address - Street 2:NUTRITION CARE DIVISION
Practice Address - City:JBLM
Practice Address - State:WA
Practice Address - Zip Code:98431-8952
Practice Address - Country:US
Practice Address - Phone:253-968-0549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI609989935133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric