Provider Demographics
NPI:1013689405
Name:POILLON, KAITLIN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:POILLON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 N AMERICAN ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1677
Mailing Address - Country:US
Mailing Address - Phone:717-715-3943
Mailing Address - Fax:
Practice Address - Street 1:1601 CHERRY ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1306
Practice Address - Country:US
Practice Address - Phone:215-553-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered