Basic Information
| Provider Information | |||||||||
| NPI: | 1639519846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLONE | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | RD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOCK | ||||||||
| OtherFirstName: | KAITLIN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | RD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3100 BLUE RIDGE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276128002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3100 BLUE RIDGE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276128002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2013 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L005082 | NC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.