Provider Demographics
NPI:1134871718
Name:SEGUIN, KAITLYN (MS, RD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2155 BRITTON RD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2155 BRITTON RD UNIT 110
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-1929
Practice Address - Country:US
Practice Address - Phone:760-445-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11129290-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered