Healthcare Provider Details

I. General information

NPI: 1053957639
Provider Name (Legal Business Name): KATILYN DAVIS MS, RD, CSSD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 W COLONY RD
FOWLER MI
48835-9717
US

IV. Provider business mailing address

9915 W COLONY RD
FOWLER MI
48835-9717
US

V. Phone/Fax

Practice location:
  • Phone: 989-906-2459
  • Fax:
Mailing address:
  • Phone: 989-906-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: