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General NPI Number Information
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NPI Number | 1114623592
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Entity Type | Individual
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Provider Name | KAITLIN NICOLE GRAY RD, CSSD, LD
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 2817 ROCK MERRITT AVE
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City | FORT LIBERTY
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State | NC
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Zip | 28310-7394
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Country | US
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Telephone | 910-907-8922
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Fax | 910-907-6069
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Provider Business Mailing Address
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Address Line | 110 RUTLEDGE LN
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City | PINEHURST
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State | NC
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Zip | 28374-7026
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Country | US
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Telephone | 815-742-3972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number | ND9335
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License Number State | FL
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