Provider Demographics
NPI:1477949535
Name:MELLENDICK, KEVAN MCCURNIN (PHD, RDN, CSCS)
Entity Type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:MCCURNIN
Last Name:MELLENDICK
Suffix:
Gender:M
Credentials:PHD, RDN, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 TERRIER DR
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-7217
Mailing Address - Country:US
Mailing Address - Phone:410-627-3247
Mailing Address - Fax:
Practice Address - Street 1:5720 INTEGRITY DRIVE
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-2180
Practice Address - Country:US
Practice Address - Phone:901-874-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1071646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered