Provider Demographics
NPI:1033910633
Name:LYDICK, KENNON (RD, LD)
Entity type:Individual
Prefix:
First Name:KENNON
Middle Name:
Last Name:LYDICK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 LEONA ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2119
Mailing Address - Country:US
Mailing Address - Phone:512-627-2297
Mailing Address - Fax:
Practice Address - Street 1:4408 SPICEWOOD SPRINGS RD STE 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8504
Practice Address - Country:US
Practice Address - Phone:512-655-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered