Provider Demographics
NPI:1356770804
Name:REED, KAITLYNN (RD)
Entity type:Individual
Prefix:MRS
First Name:KAITLYNN
Middle Name:
Last Name:REED
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 1:3319 W 5TH ST
Mailing Address - Street 2:APT. D
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2154
Mailing Address - Country:US
Mailing Address - Phone:816-210-1655
Mailing Address - Fax:
Practice Address - Street 1:3319 W 5TH ST
Practice Address - Street 2:APT. D
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2154
Practice Address - Country:US
Practice Address - Phone:816-210-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered