1598221285 NPI number — MRS. KAYLA SCHIMETZ MS, RD, LDN

Table of content: MRS. KAYLA SCHIMETZ MS, RD, LDN (NPI 1598221285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598221285 NPI number — MRS. KAYLA SCHIMETZ MS, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHIMETZ
Provider First Name:
KAYLA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALBRECHT
Provider Other First Name:
KAYLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RD, LDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598221285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 E. STATE STREET
Provider Second Line Business Mailing Address:
NUTRITION CENTER, CAMELOT TOWER
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
779-696-4664
Provider Business Mailing Address Fax Number:
608-267-8148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 E. STATE STREET
Provider Second Line Business Practice Location Address:
NUTRITION CENTER, CAMELOT TOWER
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
779-696-4664
Provider Business Practice Location Address Fax Number:
608-267-8148
Provider Enumeration Date:
02/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  164007575 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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