Provider Demographics
NPI:1538841135
Name:BRAZELTON, KYLEE A (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:A
Last Name:BRAZELTON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 SW EGRET POND CIR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2535
Mailing Address - Country:US
Mailing Address - Phone:608-397-4612
Mailing Address - Fax:
Practice Address - Street 1:2512 SW EGRET POND CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2535
Practice Address - Country:US
Practice Address - Phone:608-397-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9533133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered