Provider Demographics
NPI:1023826807
Name:FIELD, KILEY (MS, RD, CSSD)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:FIELD
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 DONNER PASS RD STE 1-924
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0449
Mailing Address - Country:US
Mailing Address - Phone:408-679-2488
Mailing Address - Fax:
Practice Address - Street 1:12030 DONNER PASS RD STE 1-924
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0449
Practice Address - Country:US
Practice Address - Phone:408-679-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86113860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered