MEDICARE: KYLIE SERIE RD

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	MED-NUTR-LIC-100458	MT
2	133V00000X	Registered Dietitian	0801	SD

General Provider Information

NPI Number	:	1871166611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE SERIE RD

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6308 S BEAL AVE APT 8
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5190
Country	:	US
Telephone Number	:	605-880-2975
Fax Number	:

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

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	02/25/2022

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Directions to “ KYLIE SERIE RD” Practice Location

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