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NPI Code Detail

MEDICARE: KATELYN RAE DAVID RDN, LDN

MEDICARE: KATELYN RAE DAVID RDN, LDN
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
1133V00000XRegistered DietitianL009059NC

General Provider Information

NPI Number : 1831055490
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN RAE DAVID RDN, LDN
Provider Business Mailing Address
First Line : 1615 MOCKINGBIRD LN APT 539
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-3926
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1615 MOCKINGBIRD LN APT 539
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-3926
Country : US
Telephone Number : 630-806-4726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2025
Last Update Date : 12/29/2025

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