Provider Demographics
NPI:1033977848
Name:MERSHON, KATHRYN STUART (RDN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:STUART
Last Name:MERSHON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MERSHON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:159 W 100 N APT 2
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4529
Mailing Address - Country:US
Mailing Address - Phone:801-837-3136
Mailing Address - Fax:
Practice Address - Street 1:848 W 1455 N STE 130
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5801
Practice Address - Country:US
Practice Address - Phone:801-837-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10401429-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered