Provider Demographics
NPI:1568258119
Name:HOUGH, KAYLEE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:HOUGH
Suffix:
Gender:
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 51ST ST W APT 1814
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-5116
Mailing Address - Country:US
Mailing Address - Phone:724-902-2221
Mailing Address - Fax:
Practice Address - Street 1:4802 51ST ST W APT 1814
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-5116
Practice Address - Country:US
Practice Address - Phone:724-902-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD007011133V00000X
TXDT92024133V00000X
FLND12883133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered