MEDICARE: KYLEIGH KIRBACH RDN

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	2014030567	MO
2	207R00000X	Internal Medicine Physician	2024025878	MO

General Provider Information

NPI Number	:	1891154175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEIGH KIRBACH RDN

Provider Business Mailing Address
First Line	:	7329 BALSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2902
Country	:	US
Telephone Number	:	217-502-2784
Fax Number	:

Provider Business Practice Location Address
First Line	:	7329 BALSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2902
Country	:	US
Telephone Number	:	217-502-2784
Fax Number	:

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	09/08/2024

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