Provider Demographics
NPI:1003454067
Name:KHALAF, KALYN LEE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KALYN
Middle Name:LEE
Last Name:KHALAF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:KALYN
Other - Middle Name:LEE
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:15800 LANGLEY WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-0001
Mailing Address - Country:US
Mailing Address - Phone:405-361-1040
Mailing Address - Fax:
Practice Address - Street 1:15800 LANGLEY WAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-0001
Practice Address - Country:US
Practice Address - Phone:405-361-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86062373133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered