Provider Demographics
NPI:1669002143
Name:MOUAT, KAYLEIGH MARIE (RD)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:MARIE
Last Name:MOUAT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:MARIE
Other - Last Name:TELEMAQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2705 N LEBANON ST STE 305
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-8622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 W OAK ST STE 203
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-3836
Practice Address - Country:US
Practice Address - Phone:317-873-1200
Practice Address - Fax:317-873-1209
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered