Provider Demographics
NPI:1689067944
Name:MCCAY, OLIVIA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MCCAY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5229
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-5229
Mailing Address - Country:US
Mailing Address - Phone:601-984-3126
Mailing Address - Fax:
Practice Address - Street 1:603 DULING AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4009
Practice Address - Country:US
Practice Address - Phone:601-984-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1076133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered