Provider Demographics
NPI:1295058212
Name:HEAD, KAY (RD LD)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 W RIECK RD
Mailing Address - Street 2:#246
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3136
Mailing Address - Country:US
Mailing Address - Phone:903-571-0553
Mailing Address - Fax:979-530-9551
Practice Address - Street 1:424 W RIECK RD
Practice Address - Street 2:#246
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3136
Practice Address - Country:US
Practice Address - Phone:903-571-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered