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NPI Code Detail

MEDICARE: KELLY MARIE MCCORKLE RD

MEDICARE: KELLY MARIE MCCORKLE RD
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
1133V00000XRegistered Dietitian86146828

General Provider Information

NPI Number : 1538949995
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MARIE MCCORKLE RD
Provider Business Mailing Address
First Line : 1061 HARMON AVE
Second Line :
City : FORT STEWART
State : GA
Zip : 31314-5641
Country : US
Telephone Number : 571-801-0731
Fax Number :
Provider Business Practice Location Address
First Line : 1061 HARMON AVE
Second Line :
City : FORT STEWART
State : GA
Zip : 31314-5641
Country : US
Telephone Number : 571-801-0731
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2023
Last Update Date : 03/06/2026

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