Provider Demographics
NPI:1215689898
Name:DIETITIAN KAITLYN LLC
Entity type:Organization
Organization Name:DIETITIAN KAITLYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:910-408-5338
Mailing Address - Street 1:2155 BRITTON RD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1929
Mailing Address - Country:US
Mailing Address - Phone:910-408-5338
Mailing Address - Fax:
Practice Address - Street 1:2155 BRITTON RD UNIT 110
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-1929
Practice Address - Country:US
Practice Address - Phone:910-408-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty