Provider Demographics
NPI:1477179646
Name:JOHNSON, KAYLA LYNNE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:LYNNE
Last Name:JOHNSON
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 1:570 COBRA CT
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5694
Mailing Address - Country:US
Mailing Address - Phone:906-235-4123
Mailing Address - Fax:
Practice Address - Street 1:570 COBRA CT
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5694
Practice Address - Country:US
Practice Address - Phone:906-235-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered