Provider Demographics
NPI:1306410683
Name:FARRELL, KAITLYN SARA (RD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:SARA
Last Name:FARRELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6211
Mailing Address - Country:US
Mailing Address - Phone:847-636-7761
Mailing Address - Fax:
Practice Address - Street 1:1335 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6211
Practice Address - Country:US
Practice Address - Phone:847-636-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty