Provider Demographics
NPI:1124378609
Name:PAYNE, KATHLEEN S (RD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:S
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 266
Mailing Address - Street 2:
Mailing Address - City:ALLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08720
Mailing Address - Country:US
Mailing Address - Phone:732-829-2074
Mailing Address - Fax:732-974-7427
Practice Address - Street 1:3244 RIDGEWOOD RD.
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08720
Practice Address - Country:US
Practice Address - Phone:732-829-2074
Practice Address - Fax:732-974-7427
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00477442133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered