Provider Demographics
NPI:1518487107
Name:WILK, KAITLIN (RD)
Entity type:Individual
Prefix:MISS
First Name:KAITLIN
Middle Name:
Last Name:WILK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:GLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 BRIGHT ST UNIT 507
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4766
Mailing Address - Country:US
Mailing Address - Phone:845-774-9947
Mailing Address - Fax:
Practice Address - Street 1:1212 MANN DR STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5511
Practice Address - Country:US
Practice Address - Phone:704-584-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered