Provider Demographics
NPI:1922252972
Name:WHALEY, KELLEIGH (MS, RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:KELLEIGH
Middle Name:
Last Name:WHALEY
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 1:809 GRICKLE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7575
Mailing Address - Country:US
Mailing Address - Phone:405-514-7742
Mailing Address - Fax:
Practice Address - Street 1:809 GRICKLE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7575
Practice Address - Country:US
Practice Address - Phone:405-514-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1458133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered