Provider Demographics
NPI:1144462805
Name:MCLAURY, KIMBERLY CLAIRE (RD)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:CLAIRE
Last Name:MCLAURY
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:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:MOCLIPS
Mailing Address - State:WA
Mailing Address - Zip Code:98562-0373
Mailing Address - Country:US
Mailing Address - Phone:360-276-4405
Mailing Address - Fax:360-276-4474
Practice Address - Street 1:1505 KLA-OOK-WA DRIVE
Practice Address - Street 2:
Practice Address - City:TAHOLAH
Practice Address - State:WA
Practice Address - Zip Code:98587-0219
Practice Address - Country:US
Practice Address - Phone:360-276-4405
Practice Address - Fax:360-276-4474
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60076273133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered