Healthcare Provider Details

I. General information

NPI: 1598670416
Provider Name (Legal Business Name): KYRA ELIZABETH CONTRIS MFN, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581A CORTLAND AVE
MYRTLE BEACH SC
29579-9100
US

IV. Provider business mailing address

5855 SWAN RD
PEMBERVILLE OH
43450-9482
US

V. Phone/Fax

Practice location:
  • Phone: 419-601-5599
  • Fax:
Mailing address:
  • Phone: 419-601-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86293730
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: