Healthcare Provider Details

I. General information

NPI: 1093370330
Provider Name (Legal Business Name): TAYLOR KUYKENDALL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 NE 15TH ST
MOORE OK
73160-8643
US

IV. Provider business mailing address

408 SW 145TH ST
OKLAHOMA CITY OK
73170-7298
US

V. Phone/Fax

Practice location:
  • Phone: 316-617-1427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: