Healthcare Provider Details

I. General information

NPI: 1629967062
Provider Name (Legal Business Name): KATELYN ANN SMITH RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 WALNUT ST
NEW HOLLAND PA
17557-9710
US

IV. Provider business mailing address

831 WALNUT ST
NEW HOLLAND PA
17557-9710
US

V. Phone/Fax

Practice location:
  • Phone: 717-371-9999
  • Fax:
Mailing address:
  • Phone: 717-371-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86391828
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008639
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: