Provider Demographics
NPI:1497637227
Name:TITCOMB, TYLER J (RDN)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:TITCOMB
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 159TH ST
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-7702
Mailing Address - Country:US
Mailing Address - Phone:218-242-1879
Mailing Address - Fax:
Practice Address - Street 1:2100 S 36TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-1200
Practice Address - Fax:913-588-1212
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3350133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered