Provider Demographics
NPI:1003171463
Name:MELKO, KATHRYN ELIZABETH (PHD, RD, CDE)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:MELKO
Suffix:
Gender:F
Credentials:PHD, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 BELFORT RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1409
Mailing Address - Country:US
Mailing Address - Phone:904-450-6317
Mailing Address - Fax:
Practice Address - Street 1:4203 BELFORT RD
Practice Address - Street 2:SUITE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1409
Practice Address - Country:US
Practice Address - Phone:904-450-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7112133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND7112OtherLICENSED NUTRITIONIST/DIETITIAN