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Organization
YOUR SPECIALIZED DIETITIAN
Active
Organization
YOUR SPECIALIZED DIETITIAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE FIELDING ROSE RD (OWNER)
(903) 816-3657
Entity
Organization
Contact information
Practice address
408 W MAIN ST, WHITESBORO, TX 76273-1641
(903) 816-3657
(817) 977-7406
Mailing address
408 WEST MAIN ST, WHITESBORO, TX 76273
(903) 816-3657
(817) 977-7406
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT80568
TX
Other
Enumeration date
03/30/2015
Last updated
03/30/2015
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