Provider Demographics
NPI:1104706969
Name:CAPEN, KATIE JOANNE (RD, LD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JOANNE
Last Name:CAPEN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 SW PELICAN CRES
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2426
Mailing Address - Country:US
Mailing Address - Phone:772-285-8186
Mailing Address - Fax:
Practice Address - Street 1:1172 SW PELICAN CRES
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2426
Practice Address - Country:US
Practice Address - Phone:772-285-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11462133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty