Basic Information
| Provider Information | |||||||||
| NPI: | 1629401773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONFORT | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5448 RIVER TRL | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458071319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192283335 | ||||||||
| FaxNumber: | 4199984721 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 BELLEFONTAINE AVE | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458042800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192283335 | ||||||||
| FaxNumber: | 4199984721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD 6237 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.