Provider Demographics
NPI:1679031652
Name:LANGBEHN, KATHRYN ALIE (MS, RDN, CPT, PN1)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ALIE
Last Name:LANGBEHN
Suffix:
Gender:F
Credentials:MS, RDN, CPT, PN1
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:ELIZABEGTH
Other - Last Name:ALIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RND, CPT, PN1
Mailing Address - Street 1:1502 RUSTADS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1131
Mailing Address - Country:US
Mailing Address - Phone:757-603-1187
Mailing Address - Fax:
Practice Address - Street 1:1309 JAMESTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3380
Practice Address - Country:US
Practice Address - Phone:757-566-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA859055133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered