Provider Demographics
NPI:1265292676
Name:YANOW, KYLIE (MS, RDN, CPT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:YANOW
Suffix:
Gender:F
Credentials:MS, RDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5611
Mailing Address - Country:US
Mailing Address - Phone:513-490-2932
Mailing Address - Fax:
Practice Address - Street 1:4624 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5611
Practice Address - Country:US
Practice Address - Phone:513-490-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered