Provider Demographics
NPI:1053825174
Name:LANDEL, KATHRYN ELIZABETH (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:LANDEL
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9101 N CENTRAL EXPY STE 370
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5947
Mailing Address - Country:US
Mailing Address - Phone:214-820-2969
Mailing Address - Fax:214-820-8219
Practice Address - Street 1:9101 N CENTRAL EXPY STE 370
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5947
Practice Address - Country:US
Practice Address - Phone:215-820-8220
Practice Address - Fax:214-820-8219
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86052291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT83832OtherTEXAS STATE BOARD OF EXAMINERS OF DIETITIANS
86052291OtherCOMMISSION ON DIETETIC REGISTRATION