Healthcare Provider Details

I. General information

NPI: 1225577802
Provider Name (Legal Business Name): KAYLYN SPETH RD, LD, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 POYNTZ AVE
MANHATTAN KS
66502-6355
US

IV. Provider business mailing address

720 POYNTZ AVE
MANHATTAN KS
66502-6355
US

V. Phone/Fax

Practice location:
  • Phone: 785-587-7144
  • Fax:
Mailing address:
  • Phone: 785-587-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1906
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: