Provider Demographics
NPI:1528182417
Name:MCCOMBS, KELLY LYNN (MS, RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BARNWELL DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1104
Mailing Address - Country:US
Mailing Address - Phone:843-368-4725
Mailing Address - Fax:
Practice Address - Street 1:990 RIBAUT RD
Practice Address - Street 2:LIFEFIT DIABETES CENTER
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-8011
Practice Address - Country:US
Practice Address - Phone:843-368-4725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC771133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2992596Medicare ID - Type UnspecifiedREGISTERED DIETITIAN
NCP81354Medicare UPIN