Provider Demographics
NPI:1679119259
Name:KEGLEY, LINDSEY WALLACE (RDN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:WALLACE
Last Name:KEGLEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 NEW GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:VA
Mailing Address - Zip Code:24225-6252
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 COLLEGE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-2460
Practice Address - Country:US
Practice Address - Phone:276-964-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered