Provider Demographics
NPI:1568171684
Name:KENT, KATELYNN (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:KATELYNN
Middle Name:
Last Name:KENT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 SHOUP MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3979
Mailing Address - Country:US
Mailing Address - Phone:937-275-3488
Mailing Address - Fax:
Practice Address - Street 1:1435 SHOUP MILL RD STE A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3979
Practice Address - Country:US
Practice Address - Phone:937-275-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86147061133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered