Healthcare Provider Details

I. General information

NPI: 1447758412
Provider Name (Legal Business Name): KAYLEY ELIZABETH GEORGE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 GARTH RD
BAYTOWN TX
77521-9638
US

IV. Provider business mailing address

9222 TURTLE POND LN
MISSOURI CITY TX
77459-6970
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-1149
  • Fax:
Mailing address:
  • Phone: 281-299-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT85148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: