Provider Demographics
NPI:1902687155
Name:NACE, KAITLYN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:NACE
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 1:2752 EDINBURGH CHANNEL RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5674
Mailing Address - Country:US
Mailing Address - Phone:423-946-0977
Mailing Address - Fax:
Practice Address - Street 1:2752 EDINBURGH CHANNEL RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-5674
Practice Address - Country:US
Practice Address - Phone:423-946-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered