Provider Demographics
NPI:1588835367
Name:DAVY-MCCLURE, KIM M (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:M
Last Name:DAVY-MCCLURE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:M
Other - Last Name:DAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:5770 S 250 E
Practice Address - Street 2:SUITE 310
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8100
Practice Address - Country:US
Practice Address - Phone:801-314-4500
Practice Address - Fax:801-314-2909
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5387258-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered