Provider Demographics
NPI:1073880464
Name:CARLSON, KAYLA MAE (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MAE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:MS
Other - First Name:KAYLA
Other - Middle Name:MAE
Other - Last Name:KRAGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-5000
Mailing Address - Fax:218-828-7579
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE 2500
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-5000
Practice Address - Fax:218-828-7579
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3066133V00000X
MN1058649133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered