Individual provider Active NPI

Kyle Keller, RD

  • Registered Dietitian
  • Redlands, CA
National Provider Identifier
1437874641
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86303323 Issued in CA
Practice address
112 E Olive Ave Ste E
Redlands, CA 92373-5281
Phone
(909) 600-2113
NPI assigned
Oct 10, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86303323 CA Primary

Addresses

Primary practice location

112 E Olive Ave Ste E
Redlands, CA 92373-5281

Mailing address

7155 Citrus Ave Unit 115
Fontana, CA 92336-6001
Phone (909) 900-9655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240621000536 CA Practitioner - Registered Dietitian Or Nutrition Professional 6305214248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2079 Orange Tree LN
Redlands, CA 92374-2849
Phone (757) 585-3441

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
86303323CAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Newbody Inc Dietitian, Registered CurrentSince Aug 15, 2024 Accepting new patients

Locations

112 E Olive Ave
Redlands, CA 92373

112 E Olive Ave
Ste E
Redlands, CA 92373
Phone (909) 600-2113

2079 Orange Tree Ln
Redlands, CA 92374
Phone (909) 353-7053

1309 Jamestown Rd
Ste 102
Williamsburg, VA 23185
Phone (757) 220-4917

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1437874641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7155 CITRUS AVE UNIT 115",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923366001",
            "telephone_number": "909-900-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E OLIVE AVE STE E",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735281",
            "telephone_number": "909-600-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "KYLE",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-10",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86303323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.