Provider Demographics
NPI:1841918935
Name:THE FRIENDLY DIETITIAN, LLC
Entity type:Organization
Organization Name:THE FRIENDLY DIETITIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:307-690-8911
Mailing Address - Street 1:1827 N RUTLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5007
Mailing Address - Country:US
Mailing Address - Phone:307-690-8911
Mailing Address - Fax:
Practice Address - Street 1:901 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4635
Practice Address - Country:US
Practice Address - Phone:307-690-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty