Provider Demographics
NPI:1467624858
Name:ROSE, KYLE FIELDING (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:FIELDING
Last Name:ROSE
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 DRIFTWOOD TERRACE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209
Mailing Address - Country:US
Mailing Address - Phone:903-816-3657
Mailing Address - Fax:903-416-2098
Practice Address - Street 1:520 DRIFTWOOD TERRACE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209
Practice Address - Country:US
Practice Address - Phone:903-816-3657
Practice Address - Fax:903-416-2098
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80568133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered