Provider Demographics
NPI:1932867108
Name:CONNER, KYLIE A (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:A
Last Name:CONNER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 SARATOGA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-1896
Mailing Address - Country:US
Mailing Address - Phone:805-458-0271
Mailing Address - Fax:
Practice Address - Street 1:1503 SARATOGA AVE APT A
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-1896
Practice Address - Country:US
Practice Address - Phone:805-458-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered