Provider Demographics
NPI:1336035997
Name:FLETCHER, KEVIN R JR (RDN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:FLETCHER
Suffix:JR
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:KILLINGLY
Mailing Address - State:CT
Mailing Address - Zip Code:06241-1628
Mailing Address - Country:US
Mailing Address - Phone:860-942-2936
Mailing Address - Fax:
Practice Address - Street 1:154 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:KILLINGLY
Practice Address - State:CT
Practice Address - Zip Code:06241-1628
Practice Address - Country:US
Practice Address - Phone:860-942-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6946133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered