Provider Demographics
NPI:1518677491
Name:GWALTNEY, KATELYN JILL (MPH, RD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:JILL
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:JILL
Other - Last Name:UHLIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13998 TERN LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-4554
Mailing Address - Country:US
Mailing Address - Phone:586-582-2855
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-8200
Practice Address - Country:US
Practice Address - Phone:727-310-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered