Provider Demographics
NPI:1235432535
Name:KEGG, GAYLE (RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:
Last Name:KEGG
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 N FOXCLIFF DR W
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-5957
Mailing Address - Country:US
Mailing Address - Phone:765-342-9937
Mailing Address - Fax:
Practice Address - Street 1:3946 N FOXCLIFF DR W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-5957
Practice Address - Country:US
Practice Address - Phone:765-342-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000702A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered