| Doctor Name: | KYLE BLANTON |
| NPI Number: | 1215300835 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RD, LDN, LD |
| License Number: | 1096369 |
| Business Practice Address: | 707a E. Prien Lake Rd. Lake Charles, LA - 70601 |
| Business Phone Number: | 3374786020 |
| Business Fax Number: | |
| Mailing Address: | 707 A E. Prien Lake Rd., LAKE CHARLES |
| State: | LA |
| Postal Code: | 70601 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2015 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1096369 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |