Provider Demographics
NPI:1962109124
Name:AARON, KYLIE (RDN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:
Last Name:AARON
Suffix:
Gender:F
Credentials:RDN, IBCLC
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2046 E MINTON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2046 E MINTON DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7436
Practice Address - Country:US
Practice Address - Phone:480-415-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-307192174N00000X
AZ86049643133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN