Provider Demographics
NPI:1952472466
Name:POMEROY, KAY CALLAHAN (MS, MSW, RD)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:CALLAHAN
Last Name:POMEROY
Suffix:
Gender:F
Credentials:MS, MSW, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6896 EMERALD SHORES DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1438
Mailing Address - Country:US
Mailing Address - Phone:248-879-6744
Mailing Address - Fax:248-879-7008
Practice Address - Street 1:6896 EMERALD SHORES DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1438
Practice Address - Country:US
Practice Address - Phone:248-879-6744
Practice Address - Fax:248-879-7008
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N87980Medicare ID - Type Unspecified