Individual
KELLY JO MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,LD
Contact information
Practice address
5308 N GALLOWAY AVE STE 200, MESQUITE, TX 75150-1125
(214) 358-2300
(214) 579-6754
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-0334
(214) 645-0078
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT81969
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DT81696
TX LICENSE
TX
Enumeration date
12/29/2010
Last updated
01/04/2021
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