Provider Demographics
NPI:1144851221
Name:MCCAUGHEY, KRYSTEN (MS, RD)
Entity type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:MCCAUGHEY
Suffix:
Gender:F
Credentials:MS, 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 181349
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92178-1349
Mailing Address - Country:US
Mailing Address - Phone:909-519-4375
Mailing Address - Fax:
Practice Address - Street 1:2081 FARADAY AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7230
Practice Address - Country:US
Practice Address - Phone:909-519-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics