Provider Demographics
NPI:1780126847
Name:MCGEEHAN, CARLY RAE (RD, LD)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:RAE
Last Name:MCGEEHAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:RAE
Other - Last Name:YANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5202 BETHEL REED PARK STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1818
Mailing Address - Country:US
Mailing Address - Phone:614-447-9495
Mailing Address - Fax:
Practice Address - Street 1:5202 BETHEL REED PARK STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1818
Practice Address - Country:US
Practice Address - Phone:614-447-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD7960133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLD7960OtherTHE OHIO BOARD OF DIETETICS
86041140OtherCOMMISSION ON DIETETIC REGISTRATION - ACADEMY OF NUTRITION AND DIETETICS