Provider Demographics
NPI:1629795919
Name:MULCAHY, KELLY (HNC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:HNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16132 S THAYER RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9383
Mailing Address - Country:US
Mailing Address - Phone:503-707-4220
Mailing Address - Fax:
Practice Address - Street 1:16132 S THAYER RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9383
Practice Address - Country:US
Practice Address - Phone:503-707-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist