Provider Demographics
NPI:1649755760
Name:FISHER, KAITLYN A (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-1417
Mailing Address - Country:US
Mailing Address - Phone:419-796-7536
Mailing Address - Fax:
Practice Address - Street 1:1571 COVINGTON AVE # 3B
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2830
Practice Address - Country:US
Practice Address - Phone:937-451-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.8072133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered