Provider Demographics
NPI:1538624325
Name:STANSBERRY, KYLE LOUIS (RDN)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:LOUIS
Last Name:STANSBERRY
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 UPHAM DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9403
Mailing Address - Country:US
Mailing Address - Phone:989-506-1179
Mailing Address - Fax:
Practice Address - Street 1:8080 UPHAM DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9403
Practice Address - Country:US
Practice Address - Phone:989-506-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered