Provider Demographics
NPI:1962264556
Name:FRYE, KATLYN MARIE (RD, CSSD, ACSM-CPT)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:MARIE
Last Name:FRYE
Suffix:
Gender:F
Credentials:RD, CSSD, ACSM-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHELTENHAM DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2334
Mailing Address - Country:US
Mailing Address - Phone:540-327-8191
Mailing Address - Fax:
Practice Address - Street 1:101 CHELTENHAM DR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2334
Practice Address - Country:US
Practice Address - Phone:540-327-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1058829133VN1501X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics