Healthcare Provider Details

I. General information

NPI: 1508798570
Provider Name (Legal Business Name): KAITLYN NEWELL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

IV. Provider business mailing address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

V. Phone/Fax

Practice location:
  • Phone: 785-623-5176
  • Fax: 785-623-5529
Mailing address:
  • Phone: 785-623-5176
  • Fax: 785-623-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3877
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: