Healthcare Provider Details

I. General information

NPI: 1659082626
Provider Name (Legal Business Name): KAYLEY GEORGE REGISTERED DIETITIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17602 MCDONALD RD
ALVIN TX
77511-1913
US

IV. Provider business mailing address

920 CAMP DR
WACO TX
76710-4642
US

V. Phone/Fax

Practice location:
  • Phone: 281-299-2844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KAYLEY GEORGE
Title or Position: OWNER
Credential:
Phone: 281-299-2844