MEDICARE: KAYLA JOHNSON MS, RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1609622331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA JOHNSON MS, RD, LDN

Provider Business Mailing Address
First Line	:	3724 JEFFERSON ST STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-6204
Country	:	US
Telephone Number	:	618-204-2262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1652 N SPANISH ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-7051
Country	:	US
Telephone Number	:	618-204-2262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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