Provider Demographics
NPI:1881215531
Name:HAYCOX, KACEY (RD/DL)
Entity Type:Individual
Prefix:MRS
First Name:KACEY
Middle Name:
Last Name:HAYCOX
Suffix:
Gender:F
Credentials:RD/DL
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4813
Mailing Address - Country:US
Mailing Address - Phone:432-221-3396
Mailing Address - Fax:432-221-3096
Practice Address - Street 1:4214 ANDREWS HWY STE 107
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4813
Practice Address - Country:US
Practice Address - Phone:432-221-3396
Practice Address - Fax:432-221-3096
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84642133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered