Provider Demographics
NPI:1013522408
Name:COTHERN, CAITLIN RAE (RD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:RAE
Last Name:COTHERN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E LAWSON RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8739
Mailing Address - Country:US
Mailing Address - Phone:870-530-2722
Mailing Address - Fax:
Practice Address - Street 1:306 E LAWSON RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8739
Practice Address - Country:US
Practice Address - Phone:870-530-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1994133N00000X, 133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist