MEDICARE: KAITLYN MICHENER MS, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD007670	GA

General Provider Information

NPI Number	:	1386436848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN MICHENER MS, RD, LD

Provider Business Mailing Address
First Line	:	1881 SS RAILROAD BED RD APT 2801
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-8617
Country	:	US
Telephone Number	:	440-258-0260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 SS RAILROAD BED RD APT 2801
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-8617
Country	:	US
Telephone Number	:	440-258-0260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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