Provider Demographics
NPI:1891911806
Name:DUYSEN-PEACOCK, KAY (MS, RD)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:DUYSEN-PEACOCK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:DUYSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD
Mailing Address - Street 1:8333 FELCH ST
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1698
Mailing Address - Country:US
Mailing Address - Phone:616-772-4644
Mailing Address - Fax:
Practice Address - Street 1:8333 FELCH ST
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1698
Practice Address - Country:US
Practice Address - Phone:616-772-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered