Provider Demographics
NPI:1508568700
Name:FREDERE, CAITLYN MARIE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MARIE
Last Name:FREDERE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:MARIE
Other - Last Name:AKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:3859 SMOKEY QUARTZ CT APT 2A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-8624
Mailing Address - Country:US
Mailing Address - Phone:828-386-7164
Mailing Address - Fax:
Practice Address - Street 1:306 POMONA DR STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1643
Practice Address - Country:US
Practice Address - Phone:336-541-6475
Practice Address - Fax:336-541-6485
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered