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Individual
KATLYN CUSACK
Active
Individual
KATLYN CUSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN, PA-C
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
86103286
NJ
363A00000X
Physician Assistant
Primary
25MP00909300
NJ
363AM0700X
Medical Physician Assistant
25MP00909300
NJ
363AS0400X
Surgical Physician Assistant
25MP00909300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86103286
CDR
NJ
Enumeration date
04/22/2019
Last updated
01/28/2025
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