Provider Demographics
NPI:1760703045
Name:WORLEY, KELLILYN (MS, RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:KELLILYN
Middle Name:
Last Name:WORLEY
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30153 SANDY LANDING RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36421-9157
Mailing Address - Country:US
Mailing Address - Phone:409-454-0417
Mailing Address - Fax:888-977-1202
Practice Address - Street 1:985 INTERSTATE 10 N STE 110F
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4815
Practice Address - Country:US
Practice Address - Phone:409-767-8100
Practice Address - Fax:888-977-1202
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06620133V00000X
AL4080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered