Healthcare Provider Details

I. General information

NPI: 1043793912
Provider Name (Legal Business Name): TAYLOR KRISTIN KLINE PA, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

IV. Provider business mailing address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3941
  • Fax:
Mailing address:
  • Phone: 319-235-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number134496
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number093318
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: