Provider Demographics
NPI:1699473124
Name:KAITLYN STEPHENSON
Entity type:Organization
Organization Name:KAITLYN STEPHENSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPPD
Authorized Official - Phone:304-276-6024
Mailing Address - Street 1:918 BRANDON QUAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8543
Mailing Address - Country:US
Mailing Address - Phone:304-276-6024
Mailing Address - Fax:
Practice Address - Street 1:918 BRANDON QUAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8543
Practice Address - Country:US
Practice Address - Phone:304-276-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty