Provider Demographics
NPI:1477024537
Name:PETERSON, KAYLA R (RDN, CEP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RDN, CEP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:R
Other - Last Name:KRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CEP
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17700 SE 272ND ST # 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4951
Practice Address - Country:US
Practice Address - Phone:253-301-5280
Practice Address - Fax:253-627-4608
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60852957133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered