Provider Demographics
NPI:1922809706
Name:THIEL, KAITLIN (MS RDN LD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:THIEL
Suffix:
Gender:F
Credentials:MS RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E BLACK ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3332
Mailing Address - Country:US
Mailing Address - Phone:515-460-1876
Mailing Address - Fax:
Practice Address - Street 1:214 E BLACK ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3332
Practice Address - Country:US
Practice Address - Phone:515-460-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered