Provider Demographics
NPI:1073123881
Name:KLIGORA, YANCI ANN (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:YANCI
Middle Name:ANN
Last Name:KLIGORA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:YANCI
Other - Middle Name:ANN
Other - Last Name:YEATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3619 59TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4732
Mailing Address - Country:US
Mailing Address - Phone:432-271-2450
Mailing Address - Fax:
Practice Address - Street 1:4010 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1116
Practice Address - Country:US
Practice Address - Phone:806-767-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86170125133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT86370OtherLICENSED DIETITIAN
TX86170125OtherCOMMISSION ON DIETETIC REGRISTRATION