Provider Demographics
NPI:1588462675
Name:EDWARDS, CAITLYN (PHD, RD)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 ANDREA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3504
Mailing Address - Country:US
Mailing Address - Phone:214-686-9685
Mailing Address - Fax:
Practice Address - Street 1:2642 ANDREA LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3504
Practice Address - Country:US
Practice Address - Phone:214-686-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT91976133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered