Kyle Robert Anderson, MS, RD, LD
Individual provider Active NPI Registered Dietitian · Stillwater, MN
NPI 1104783406 · NPPES record last updated Feb 5, 2026
Key facts
- NPI
- 1104783406
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 3767 (MN)
- Practice address
- 310 1/2 Main St S
Stillwater, MN 55082-5126 - Phone
- (651) 243-0924
- NPI assigned
- Jan 7, 2026
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3767 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Stage Nutrition LLC | Dietitian, Registered | Current | Accepting new patients |
Locations
310 Main St S
Stillwater, MN 55082
Phone (651) 243-0924
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 3767 | MN | Yes |
Addresses
Primary practice location
310 1/2 Main St S
Stillwater, MN 55082-5126
Mailing address
310 1/2 Main St S
Stillwater, MN 55082-5126
Phone (651) 243-0924
Other providers in Stillwater, MN
- Megan Anderegg
- Kimberly A Anderson-Uzpen
- Anna Lynn Anderson
- Cassie Anderson
- Elizabeth R Anderson
- Leigha Anderson
- Lindsey Marie Kolnik Anderson
- Nicole Anderson
- Thomas S Anderson
- Caitlin Rae Anear
All providers in Stillwater, MN · Registered Dietitian in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.