Provider Demographics
NPI:1710366422
Name:SKORUPSKI, KAYLE (MS, RDN, CNSC)
Entity Type:Individual
Prefix:
First Name:KAYLE
Middle Name:
Last Name:SKORUPSKI
Suffix:
Gender:F
Credentials:MS, RDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S OCOTILLO AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6403
Mailing Address - Country:US
Mailing Address - Phone:520-586-2261
Mailing Address - Fax:520-720-6588
Practice Address - Street 1:450 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6403
Practice Address - Country:US
Practice Address - Phone:520-586-2261
Practice Address - Fax:520-720-6588
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
994237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered