Provider Demographics
NPI:1184275372
Name:KOWNACKI, KAITLYN GRACE (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:GRACE
Last Name:KOWNACKI
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 1:2002 EASTLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-1705
Mailing Address - Country:US
Mailing Address - Phone:615-697-9355
Mailing Address - Fax:
Practice Address - Street 1:2002 EASTLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-1705
Practice Address - Country:US
Practice Address - Phone:615-697-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered