Provider Demographics
NPI:1912279118
Name:LITTLE, KAYLA (RD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EASTPARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7548
Mailing Address - Country:US
Mailing Address - Phone:615-649-4741
Mailing Address - Fax:615-457-8094
Practice Address - Street 1:204 WARD CIR
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7551
Practice Address - Country:US
Practice Address - Phone:615-377-9533
Practice Address - Fax:615-457-8014
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRD1020037133V00000X
TXDT82209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered