Active NPI
Kylee Jane Fetzner, RDN
- Registered Dietitian
- Bloomington, IL
National Provider Identifier
1619565678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86167846
- Practice address
- 2909 Spangle Rd
Bloomington, IL 61705-5985 - Phone
- (815) 236-8033
- NPI assigned
- Jan 5, 2021
- 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 | 86167846 | IL | Primary |
Addresses
Primary practice location
2909 Spangle Rd
Bloomington, IL 61705-5985
Mailing address
2909 Spangle Rd
Bloomington, IL 61705-5985
Phone (815) 236-8033
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86167846 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthier Tomorrows, PLLC | Dietitian, Registered | Past | Accepting new patients |
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": "1609804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609804800000",
"number": "1619565678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2909 SPANGLE RD",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617055985",
"telephone_number": "815-236-8033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2909 SPANGLE RD",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617055985",
"telephone_number": "815-236-8033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETZNER",
"first_name": "KYLEE",
"middle_name": "JANE",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-05",
"last_updated": "2021-01-05",
"certification_date": "2021-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "86167846",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.