Provider Demographics
NPI:1528439627
Name:CUNNINGHAM, KAILEY (MS, RDN, CD)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 WOODLAND SQUARE LOOP SE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1066
Mailing Address - Country:US
Mailing Address - Phone:888-364-5977
Mailing Address - Fax:360-628-5240
Practice Address - Street 1:673 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:SUITE 330
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1066
Practice Address - Country:US
Practice Address - Phone:888-364-5977
Practice Address - Fax:360-628-5240
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60593826133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered