Kelly Jo McCullough, RD,LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT81969 Issued in TX

Practice address

5308 N Galloway Ave Ste 200
Mesquite, TX 75150-1125

Phone

(214) 358-2300

Fax

(214) 579-6754

NPI assigned

Dec 29, 2010

Last updated

Jan 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1932403300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752845347",
            "telephone_number": "214-645-0334",
            "fax_number": "214-645-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5308 N GALLOWAY AVE STE 200",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751501125",
            "telephone_number": "214-358-2300",
            "fax_number": "214-579-6754"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5323 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753907208",
            "country_code": "US",
            "telephone_number": "214-645-0334",
            "fax_number": "214-645-0078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KELLY",
        "middle_name": "JO",
        "credential": "RD,LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-29",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT81969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX LICENSE",
            "identifier": "DT81696",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy Yvonne McCain, O.D.
• Shannon Elizabeth McCants, MD
• Johnathan E McClintock
• Kimberly Lee McCracken, SLPA
• Carlos McCulloch, RT
• John William McDaniel Jr., JOHN MCDANIEL D.D.S.
• Andrea Michelle McDonald, D.C.
• Jason Sean McDonald, D.M.D.
• Breunna McGee, PT, DPT
• Erica McKee

• Registered Dietitian in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.