Healthcare Provider Details

I. General information

NPI: 1679031652
Provider Name (Legal Business Name): KATHRYN ALIE LANGBEHN MS, RDN, CPT, PN1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN ELIZABEGTH ALIE MS, RND, CPT, PN1

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 JAMESTOWN RD STE 102
WILLIAMSBURG VA
23185-3380
US

IV. Provider business mailing address

1502 RUSTADS CIR
WILLIAMSBURG VA
23188-1131
US

V. Phone/Fax

Practice location:
  • Phone: 757-566-3441
  • Fax:
Mailing address:
  • Phone: 757-603-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number859055
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: