Provider Demographics
NPI:1144547878
Name:HARRIS, KAY L (RD)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:L
Last Name:HARRIS
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 1:760 GOLF VIEW DR UNIT 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9685
Mailing Address - Country:US
Mailing Address - Phone:541-618-4400
Mailing Address - Fax:541-618-4406
Practice Address - Street 1:760 GOLF VIEW DR UNIT 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9685
Practice Address - Country:US
Practice Address - Phone:541-618-4400
Practice Address - Fax:541-618-4406
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR660133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal