Provider Demographics
NPI:1396244786
Name:KISLA, KATLYNN V (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KATLYNN
Middle Name:V
Last Name:KISLA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-1832
Mailing Address - Country:US
Mailing Address - Phone:508-254-5639
Mailing Address - Fax:
Practice Address - Street 1:14 BENNETT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770-1832
Practice Address - Country:US
Practice Address - Phone:508-254-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered