Provider Demographics
NPI:1689239634
Name:STARRETT, KATELYN (RDN, CSG, LD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:STARRETT
Suffix:
Gender:F
Credentials:RDN, CSG, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 NASCHETTE PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-5782
Mailing Address - Country:US
Mailing Address - Phone:765-714-4597
Mailing Address - Fax:
Practice Address - Street 1:3851 N RIVER RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3765
Practice Address - Country:US
Practice Address - Phone:765-463-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1045742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty