Provider Demographics
NPI:1275339533
Name:SKINNER, KATHRYN LAINE (NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LAINE
Last Name:SKINNER
Suffix:
Gender:
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CHARLOIS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1549
Mailing Address - Country:US
Mailing Address - Phone:336-999-9311
Mailing Address - Fax:
Practice Address - Street 1:150 CHARLOIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1549
Practice Address - Country:US
Practice Address - Phone:336-999-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist