Healthcare Provider Details

I. General information

NPI: 1710366422
Provider Name (Legal Business Name): KAYLE SKORUPSKI MS, RDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S OCOTILLO AVE
BENSON AZ
85602-6403
US

IV. Provider business mailing address

450 S OCOTILLO AVE
BENSON AZ
85602-6403
US

V. Phone/Fax

Practice location:
  • Phone: 520-586-2261
  • Fax: 520-720-6588
Mailing address:
  • Phone: 520-586-2261
  • Fax: 520-720-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number994237
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: