Provider Demographics
NPI:1114537289
Name:WEIGAND, KATHY ANN (RDN, CSG, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:WEIGAND
Suffix:
Gender:F
Credentials:RDN, CSG, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HIDDENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6612
Mailing Address - Country:US
Mailing Address - Phone:813-361-8123
Mailing Address - Fax:
Practice Address - Street 1:1204 HIDDENWOOD CT
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-6612
Practice Address - Country:US
Practice Address - Phone:813-361-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered