Provider Demographics
NPI:1952138257
Name:STANLEY, KAILYN MARIE (RDN)
Entity type:Individual
Prefix:MRS
First Name:KAILYN
Middle Name:MARIE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 SACAGAWEA ST
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-2966
Mailing Address - Country:US
Mailing Address - Phone:540-842-4314
Mailing Address - Fax:
Practice Address - Street 1:6623 SACAGAWEA ST
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2966
Practice Address - Country:US
Practice Address - Phone:540-842-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86115771133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered