Provider Demographics
NPI:1336499201
Name:HEDRICK, KATELYN SHINN (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:SHINN
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 E WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6712
Mailing Address - Country:US
Mailing Address - Phone:336-272-1050
Mailing Address - Fax:336-272-0155
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:#100C
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-878-6027
Practice Address - Fax:336-878-6189
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered