Active NPI
Kylie Brenna Leeper, RD
- Registered Dietitian
- San Bernardino, CA
National Provider Identifier
1225599780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86061000
- Practice address
- 2101 N Waterman Ave
San Bernardino, CA 92404-4836 - Phone
- (909) 883-9711
- NPI assigned
- Mar 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | 86061000 | ||
| Registered Dietitian | 133V00000X | 86061000 | Primary |
Addresses
Primary practice location
2101 N Waterman Ave
San Bernardino, CA 92404-4836
Mailing address
20338 Barnard Ave
Walnut, CA 91789-2468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553644800000",
"number": "1225599780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20338 BARNARD AVE",
"city": "WALNUT",
"state": "CA",
"postal_code": "917892468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 N WATERMAN AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924044836",
"telephone_number": "909-883-9711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEEPER",
"first_name": "KYLIE",
"middle_name": "BRENNA",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-27",
"last_updated": "2019-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": null,
"license": "86061000",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "86061000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.