Healthcare Provider Details

I. General information

NPI: 1851255707
Provider Name (Legal Business Name): KAITLYN BAYLESS HAYNIE MPH, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 N PARHAM RD STE 1
HENRICO VA
23229-3102
US

IV. Provider business mailing address

11416 ORCHARD PARK DR APT 434
GLEN ALLEN VA
23059-5552
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax:
Mailing address:
  • Phone: 804-514-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86329673
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: