Provider Demographics
NPI:1134775422
Name:GALLAHER, KALI RENEA (RD)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:RENEA
Last Name:GALLAHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 S MCCLINTOCK DR APT 1086
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5873
Mailing Address - Country:US
Mailing Address - Phone:614-205-7148
Mailing Address - Fax:
Practice Address - Street 1:3501 S MCCLINTOCK DR APT 1086
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5873
Practice Address - Country:US
Practice Address - Phone:614-205-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered