Provider Demographics
NPI:1528639333
Name:CHAMPAGNE, KYLEE ANN (RD)
Entity type:Individual
Prefix:MRS
First Name:KYLEE
Middle Name:ANN
Last Name:CHAMPAGNE
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 1:62300 BAYOU JACOB RD
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-5524
Mailing Address - Country:US
Mailing Address - Phone:225-385-5355
Mailing Address - Fax:
Practice Address - Street 1:23460 EDEN ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-2528
Practice Address - Country:US
Practice Address - Phone:225-385-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered