Provider Demographics
NPI:1316786429
Name:THOMAS, KAYLEY (RDN, LD)
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19202 HILL RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9668
Mailing Address - Country:US
Mailing Address - Phone:740-273-1044
Mailing Address - Fax:
Practice Address - Street 1:19202 HILL RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9668
Practice Address - Country:US
Practice Address - Phone:740-273-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86277433133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered