Provider Demographics
NPI:1417596677
Name:REGENSBURGER, KYLIE (RD)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:REGENSBURGER
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 1:509 SE MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6429
Mailing Address - Country:US
Mailing Address - Phone:515-724-3885
Mailing Address - Fax:
Practice Address - Street 1:509 SE MICHAEL DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6429
Practice Address - Country:US
Practice Address - Phone:515-537-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86103888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered