Provider Demographics
NPI:1053197939
Name:COLBY, KAITLIN (CNC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:COLBY
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNC
Mailing Address - Street 1:209 LASSO FLS
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1968
Mailing Address - Country:US
Mailing Address - Phone:512-922-4213
Mailing Address - Fax:
Practice Address - Street 1:209 LASSO FLS
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1968
Practice Address - Country:US
Practice Address - Phone:512-922-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist