Healthcare Provider Details

I. General information

NPI: 1588445233
Provider Name (Legal Business Name): KAYLA CLARY NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 ASHWOOD LN
BIRMINGHAM AL
35209-8206
US

IV. Provider business mailing address

1715 ASHWOOD LN
BIRMINGHAM AL
35209-8206
US

V. Phone/Fax

Practice location:
  • Phone: 334-559-5258
  • Fax:
Mailing address:
  • Phone: 334-559-5258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KAYLA CLARY
Title or Position: OWNER
Credential: RD
Phone: 334-559-5258