Provider Demographics
NPI:1245884543
Name:CAMPBELL, KAYLIE (RDN, CSSD, LD)
Entity type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RDN, CSSD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3278 MCCALLISTER WAY
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-1322
Mailing Address - Country:US
Mailing Address - Phone:972-823-7520
Mailing Address - Fax:
Practice Address - Street 1:3278 MCCALLISTER WAY
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-1322
Practice Address - Country:US
Practice Address - Phone:972-823-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86056188133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered