Provider Demographics
NPI:1972875342
Name:HALL, KELLY MCMAHON (RD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MCMAHON
Last Name:HALL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3341
Mailing Address - Country:US
Mailing Address - Phone:713-301-6280
Mailing Address - Fax:
Practice Address - Street 1:1122 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3341
Practice Address - Country:US
Practice Address - Phone:713-301-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered