Provider Demographics
NPI:1033727854
Name:LINEWEAVER, KAY KAY LEE
Entity Type:Individual
Prefix:
First Name:KAY KAY
Middle Name:LEE
Last Name:LINEWEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAY KAY
Other - Middle Name:LEE
Other - Last Name:MCELWRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1158 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3152
Mailing Address - Country:US
Mailing Address - Phone:512-760-5469
Mailing Address - Fax:
Practice Address - Street 1:1158 MONROE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3152
Practice Address - Country:US
Practice Address - Phone:512-760-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist