Healthcare Provider Details

I. General information

NPI: 1275339533
Provider Name (Legal Business Name): KATHRYN LAINE SKINNER NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CHARLOIS BLVD STE 200
WINSTON SALEM NC
27103-1549
US

IV. Provider business mailing address

150 CHARLOIS BLVD STE 200
WINSTON SALEM NC
27103-1549
US

V. Phone/Fax

Practice location:
  • Phone: 336-999-9311
  • Fax:
Mailing address:
  • Phone: 336-999-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: