Healthcare Provider Details

I. General information

NPI: 1679171714
Provider Name (Legal Business Name): KYNDAL ELIZABETH KLOSE RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 11/27/2023
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SPICEWOOD SPRINGS RD STE 1022
AUSTIN TX
78759-8543
US

IV. Provider business mailing address

4501 SPICEWOOD SPRINGS RD STE 1022
AUSTIN TX
78759-8543
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-0898
  • Fax: 512-792-9912
Mailing address:
  • Phone: 512-257-0898
  • Fax: 512-792-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: