Provider Demographics
NPI:1639051808
Name:KOONS, KAYLYN ELISE (RD, LD)
Entity type:Individual
Prefix:
First Name:KAYLYN
Middle Name:ELISE
Last Name:KOONS
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 1:901 SW 131ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3642
Mailing Address - Country:US
Mailing Address - Phone:352-359-7775
Mailing Address - Fax:
Practice Address - Street 1:572 NEWELL DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-1907
Practice Address - Country:US
Practice Address - Phone:352-359-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14435133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered