Provider Demographics
NPI:1215124037
Name:FELTY, KYLIE CHRISTINE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:CHRISTINE
Last Name:FELTY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MS
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3432 GREYSTONE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2357
Mailing Address - Country:US
Mailing Address - Phone:512-967-3388
Mailing Address - Fax:
Practice Address - Street 1:3432 GREYSTONE DR STE 109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2357
Practice Address - Country:US
Practice Address - Phone:512-967-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered