Provider Demographics
NPI:1205343555
Name:VALIS, KAYLA (MCN, RD, LD)
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:
Last Name:VALIS
Suffix:
Gender:F
Credentials:MCN, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 GREENVILLE AVE STE N108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7035
Mailing Address - Country:US
Mailing Address - Phone:214-221-0855
Mailing Address - Fax:214-221-1437
Practice Address - Street 1:8515 GREENVILLE AVE STE N108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7035
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:214-221-1437
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered