Active NPI
Kylie Fagnano, MS, RDN, LDN
- Registered Dietitian
- Portland, ME
National Provider Identifier
1265942197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI1329
- Practice address
- 22 Dow St Apt 1
Portland, ME 04102-3325 - Phone
- (570) 220-3531
- NPI assigned
- Oct 5, 2017
- Last updated
- Oct 5, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI1329 | ME | Primary |
Addresses
Primary practice location
22 Dow St Apt 1
Portland, ME 04102-3325
Mailing address
22 Dow St Apt 1
Portland, ME 04102-3325
Phone (570) 220-3531
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI1329 | ME | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507161600000",
"number": "1265942197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 DOW ST APT 1",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041023325",
"telephone_number": "570-220-3531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 DOW ST APT 1",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041023325",
"telephone_number": "570-220-3531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGNANO",
"first_name": "KYLIE",
"credential": "MS, RDN, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-05",
"last_updated": "2017-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ME",
"license": "DI1329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.