Provider Demographics
NPI:1093346710
Name:KENNEDY, KATE MARIE (RD ,LD, RDN)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RD ,LD, RDN
Other - Prefix:
Other - First Name:ME
Other - Middle Name:
Other - Last Name:SIMPLY KATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:659 SEROTINA CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5171
Mailing Address - Country:US
Mailing Address - Phone:843-642-6727
Mailing Address - Fax:
Practice Address - Street 1:659 SEROTINA CT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5171
Practice Address - Country:US
Practice Address - Phone:843-642-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-03-05
Deactivation Date:2020-01-31
Deactivation Code:
Reactivation Date:2020-03-05
Provider Licenses
StateLicense IDTaxonomies
SC180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered