Provider Demographics
NPI:1407582844
Name:BUCHHOLZ, KAYLI HOPE (RDN)
Entity Type:Individual
Prefix:
First Name:KAYLI
Middle Name:HOPE
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KAYLI
Other - Middle Name:HOPE
Other - Last Name:BUCHHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:520 TOWN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1617
Mailing Address - Country:US
Mailing Address - Phone:605-861-9936
Mailing Address - Fax:
Practice Address - Street 1:520 TOWN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1617
Practice Address - Country:US
Practice Address - Phone:605-861-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY442606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered