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Individual

KYLE BLANTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RD, LDN, LD

Contact information

Practice address
707A E. PRIEN LAKE RD., LAKE CHARLES, LA 70601
(337) 478-6020
Mailing address
707 A E. PRIEN LAKE RD., LAKE CHARLES, LA 70601

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1096369
133V00000X
Registered Dietitian
Primary
2638
LA
133V00000X
Registered Dietitian
DT83099
TX

Other

Enumeration date
11/04/2015
Last updated
11/09/2015
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