Provider Demographics
NPI:1669466983
Name:CRANE, KYLIA BUTLER (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KYLIA
Middle Name:BUTLER
Last Name:CRANE
Suffix:
Gender:F
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 1:8805 EDENTON WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4499
Mailing Address - Country:US
Mailing Address - Phone:770-603-9204
Mailing Address - Fax:
Practice Address - Street 1:122A GORDON COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5740
Practice Address - Country:US
Practice Address - Phone:706-245-4035
Practice Address - Fax:706-245-4039
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002588133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered