Provider Demographics
NPI:1588217707
Name:DREHER, KIANESHA RENEE (RDN)
Entity type:Individual
Prefix:MRS
First Name:KIANESHA
Middle Name:RENEE
Last Name:DREHER
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:DREHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:7830 LAKE WILSON RD # 1067
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-9605
Mailing Address - Country:US
Mailing Address - Phone:407-900-6121
Mailing Address - Fax:
Practice Address - Street 1:7830 LAKE WILSON RD # 1067
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-9605
Practice Address - Country:US
Practice Address - Phone:407-900-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2025-03-29
Deactivation Date:2021-12-17
Deactivation Code:
Reactivation Date:2024-07-25
Provider Licenses
StateLicense IDTaxonomies
OHLD.09844133V00000X
GALD006519133V00000X
IL164.011855133V00000X
FLND8313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered