Provider Demographics
NPI:1134692726
Name:CADE, KAYLYN NICOLE (RD)
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:NICOLE
Last Name:CADE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 W 2ND PL APT 15-307
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1436
Mailing Address - Country:US
Mailing Address - Phone:662-392-4448
Mailing Address - Fax:
Practice Address - Street 1:12415 W 2ND PL APT 15-307
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1436
Practice Address - Country:US
Practice Address - Phone:662-392-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86068259133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered