Provider Demographics
NPI:1073689121
Name:KLEES, LYNN PARKER (RD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:PARKER
Last Name:KLEES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8818
Mailing Address - Country:US
Mailing Address - Phone:814-571-2286
Mailing Address - Fax:
Practice Address - Street 1:119 D CHANDLEE LAB
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-6109
Practice Address - Country:US
Practice Address - Phone:814-863-0616
Practice Address - Fax:814-863-6103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered