Provider Demographics
NPI:1386491215
Name:LYNCH, KYLIE (MSF RD LD)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MSF RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16161 HIGHWAY 280 STE 3
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-8424
Mailing Address - Country:US
Mailing Address - Phone:659-345-1110
Mailing Address - Fax:
Practice Address - Street 1:16161 HIGHWAY 280 STE 3
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8424
Practice Address - Country:US
Practice Address - Phone:659-345-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3228133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered