Provider Demographics
NPI:1780278119
Name:STEPHENSON, KAITLYN NICOLE (RD, MPPD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:NICOLE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:RD, MPPD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:NICOLE
Other - Last Name:CANTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, MPPD
Mailing Address - Street 1:918 BRANDON QUAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8543
Mailing Address - Country:US
Mailing Address - Phone:304-276-6024
Mailing Address - Fax:
Practice Address - Street 1:918 BRANDON QUAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8543
Practice Address - Country:US
Practice Address - Phone:304-276-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86157028133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered