Provider Demographics
NPI:1144096389
Name:RISTEEN, KAYLA (RD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RISTEEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3903
Mailing Address - Country:US
Mailing Address - Phone:908-246-0076
Mailing Address - Fax:
Practice Address - Street 1:730 FOX RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3903
Practice Address - Country:US
Practice Address - Phone:908-246-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered