Provider Demographics
NPI:1861287468
Name:PATTILLO, KAYLEE CHRISTENSEN (MDA, RDN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:CHRISTENSEN
Last Name:PATTILLO
Suffix:
Gender:F
Credentials:MDA, RDN
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:CATHERINE
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12041 DESSAU RD APT 1008
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-1713
Mailing Address - Country:US
Mailing Address - Phone:801-427-2521
Mailing Address - Fax:
Practice Address - Street 1:12041 DESSAU RD APT 1008
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-1713
Practice Address - Country:US
Practice Address - Phone:801-427-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86314675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered