Provider Demographics
NPI:1457013013
Name:WILSON, KAYLA MARIA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3734 SWETLAND DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-9082
Mailing Address - Country:US
Mailing Address - Phone:609-638-1438
Mailing Address - Fax:
Practice Address - Street 1:475 SPRING LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3918
Practice Address - Country:US
Practice Address - Phone:609-638-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006388133V00000X
86089156133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered