MEDICARE: KATIE JEAN WOLF RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86147720	FL

General Provider Information

NPI Number	:	1275162661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE JEAN WOLF RDN

Provider Business Mailing Address
First Line	:	1001 1ST ST
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-6079
Country	:	US
Telephone Number	:	727-644-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 1ST ST
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-6079
Country	:	US
Telephone Number	:	727-644-1991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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