Provider Demographics
NPI:1710389986
Name:SHOMAKER, KYLE MICHAEL (CDM, CFPP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:MICHAEL
Last Name:SHOMAKER
Suffix:
Gender:M
Credentials:CDM, CFPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:BUILDING 302
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6739
Mailing Address - Fax:912-435-6923
Practice Address - Street 1:1061 HARMON AVE BLDG 302
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-6739
Practice Address - Fax:912-435-6923
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA312779716133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education