Provider Demographics
NPI:1225826779
Name:TAYLOR, KENNIDY P (MS, RDN)
Entity type:Individual
Prefix:
First Name:KENNIDY
Middle Name:P
Last Name:TAYLOR
Suffix:
Gender:
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 VIA FIESTA
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6832
Mailing Address - Country:US
Mailing Address - Phone:805-657-9196
Mailing Address - Fax:
Practice Address - Street 1:208 VIA FIESTA
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6832
Practice Address - Country:US
Practice Address - Phone:805-657-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86415303133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered