Provider Demographics
NPI:1598551038
Name:ARSENAULT, KYLIE JUDITH (MS)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:JUDITH
Last Name:ARSENAULT
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 BOY SCOUT RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-9531
Mailing Address - Country:US
Mailing Address - Phone:248-986-5534
Mailing Address - Fax:
Practice Address - Street 1:2481 BOY SCOUT RD
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9531
Practice Address - Country:US
Practice Address - Phone:248-986-5534
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
MI86297370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered