Provider Demographics
NPI:1568098127
Name:FOUGERE, KATELYN MARIE (RD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:FOUGERE
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 1:140 CASS ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4956
Mailing Address - Country:US
Mailing Address - Phone:617-827-9333
Mailing Address - Fax:
Practice Address - Street 1:2299 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7854
Practice Address - Country:US
Practice Address - Phone:603-671-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4744133V00000X
NH1082133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered