Provider Demographics
NPI:1033089321
Name:NELSON, KAYLA ELIZABETH (MPS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MPS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 LAKE FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-1610
Mailing Address - Country:US
Mailing Address - Phone:248-826-8625
Mailing Address - Fax:
Practice Address - Street 1:1268 LAKE FOREST WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48380-1610
Practice Address - Country:US
Practice Address - Phone:248-826-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered