Basic Information
| Provider Information | |||||||||
| NPI: | 1568127462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | KYANN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4515 FAWCETT AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984186636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602815098 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9600 VETERANS DR SW | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984930003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003298387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI60330884 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.