Healthcare Provider Details

I. General information

NPI: 1477024537
Provider Name (Legal Business Name): KAYLA R PETERSON RDN, CEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA R KRANZ RDN, CEP

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 SE 272ND ST # 190
COVINGTON WA
98042-4951
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-5280
  • Fax: 253-627-4608
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60852957
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: