Individual
MCKYLIE RAELLEN LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LD
Contact information
Practice address
4213 HATCH HOLLOW LN, IDAHO FALLS, ID 83401-1675
(208) 404-4873
Mailing address
4213 HATCH HOLLOW LN, IDAHO FALLS, ID 83401-1675
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
D-1285
ID
133V00000X
Registered Dietitian
Primary
DT91391
TX
Other
Enumeration date
11/23/2024
Last updated
11/23/2024
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