Provider Demographics
NPI:1902358302
Name:TREMELLING, KAYLEE (MCN, RDN/LD/CD)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:TREMELLING
Suffix:
Gender:F
Credentials:MCN, RDN/LD/CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 ECCLES AVE APT B
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2307
Mailing Address - Country:US
Mailing Address - Phone:435-232-0002
Mailing Address - Fax:
Practice Address - Street 1:3726 ECCLES AVE APT B
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2307
Practice Address - Country:US
Practice Address - Phone:435-232-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10740267-4901133V00000X
TXDT84549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered