Provider Demographics
NPI:1033788948
Name:FLETCHER, KATHERINE ELIZABETH (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:200 CHANCERY DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8891
Mailing Address - Country:US
Mailing Address - Phone:919-333-2417
Mailing Address - Fax:
Practice Address - Street 1:809 SIMMONS ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3844
Practice Address - Country:US
Practice Address - Phone:919-731-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L006220133N00000X
86101530133V00000X
NC133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist