=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891007837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA MARIE AMAN RD, LN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2010
-----------------------------------------------------
Last Update Date | 07/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 9TH AVE NW
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-882-7874
-----------------------------------------------------
Fax | 605-882-5443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 9TH AVE NW
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-882-7874
-----------------------------------------------------
Fax | 605-882-5443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 0373
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 983916
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------