Provider Demographics
NPI:1114601085
Name:DEAN, KATHRYN (CPT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 OATLEY CT APT 9203
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3040
Mailing Address - Country:US
Mailing Address - Phone:443-254-1061
Mailing Address - Fax:
Practice Address - Street 1:302 OATLEY CT APT 9203
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3040
Practice Address - Country:US
Practice Address - Phone:443-254-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2743227133N00000X
2743226171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133N00000XDietary & Nutritional Service ProvidersNutritionist