Provider Demographics
NPI:1316598741
Name:FERNANDEZ, KATELYN MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:MARIE
Last Name:FERNANDEZ
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 1:1805 PALMCREST LN
Mailing Address - Street 2:
Mailing Address - City:PENRYN
Mailing Address - State:CA
Mailing Address - Zip Code:95663-9508
Mailing Address - Country:US
Mailing Address - Phone:916-995-4439
Mailing Address - Fax:
Practice Address - Street 1:481 PLUMAS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5075
Practice Address - Country:US
Practice Address - Phone:530-743-2409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered