Provider Demographics
NPI:1437041597
Name:MCMULLAN, KAELYN HREPSIME (RD)
Entity type:Individual
Prefix:
First Name:KAELYN
Middle Name:HREPSIME
Last Name:MCMULLAN
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 1:5 STARBOARD CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-1152
Mailing Address - Country:US
Mailing Address - Phone:518-817-6972
Mailing Address - Fax:
Practice Address - Street 1:125 WOLF RD STE 212
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1221
Practice Address - Country:US
Practice Address - Phone:518-417-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered