Provider Demographics
NPI:1609000371
Name:BUCHAN, KYLIE BETH (RDN)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:BETH
Last Name:BUCHAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10126 W CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201
Mailing Address - Country:US
Mailing Address - Phone:918-619-7871
Mailing Address - Fax:
Practice Address - Street 1:2002 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-7420
Practice Address - Country:US
Practice Address - Phone:405-307-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered