Provider Demographics
NPI:1700519907
Name:MCVAY, JAMIE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:MCVAY
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 1:504 ANITA SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8712
Mailing Address - Country:US
Mailing Address - Phone:330-338-1881
Mailing Address - Fax:
Practice Address - Street 1:504 ANITA SPRINGS CT
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8712
Practice Address - Country:US
Practice Address - Phone:330-338-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002409A133V00000X
KY122308133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered