MEDICARE: KAYCEE MULLANEY RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND6109	FL

General Provider Information

NPI Number	:	1104668490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCEE MULLANEY RDN, LDN

Provider Business Mailing Address
First Line	:	100 AUDUBON PL APT 1314
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-7139
Country	:	US
Telephone Number	:	502-599-2176
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 AUDUBON PL APT 1314
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-7139
Country	:	US
Telephone Number	:	502-599-2176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	03/08/2026

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