Provider Demographics
NPI:1013362730
Name:HANSON, KYLIE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 CHAMPIONS CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-9405
Mailing Address - Country:US
Mailing Address - Phone:620-285-5071
Mailing Address - Fax:
Practice Address - Street 1:3004 CHAMPIONS CIR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-9405
Practice Address - Country:US
Practice Address - Phone:620-285-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1035502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered