Provider Demographics
NPI:1265806871
Name:MAHON, CAITLIN MARIE (RD, LD)
Entity type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:MARIE
Last Name:MAHON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:FOOD AND NUTRITION SERVICES
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2877
Mailing Address - Country:US
Mailing Address - Phone:502-587-4292
Mailing Address - Fax:502-560-8499
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:FOOD AND NUTRITION SERVICES
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4292
Practice Address - Fax:502-560-8499
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2590133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered