Provider Demographics
NPI:1346902400
Name:MCCLORY, KAYLEIGH (CNS)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:MCCLORY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 CHESTNUT STREET
Mailing Address - Street 2:FRONT 1 PMB151
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:978-501-3352
Mailing Address - Fax:
Practice Address - Street 1:18 HUBBARD ST APT 3
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3878
Practice Address - Country:US
Practice Address - Phone:978-501-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
17911OtherBOARD FOR CERTIFICATION OF NUTRITION SPECIALISTS