Provider Demographics
NPI:1164519872
Name:REDLE, KATHRYN A (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:REDLE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RED FOX DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-8647
Mailing Address - Country:US
Mailing Address - Phone:307-674-4642
Mailing Address - Fax:
Practice Address - Street 1:1898 FORT RD
Practice Address - Street 2:VA MEDICAL CENTER (120)
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8320
Practice Address - Country:US
Practice Address - Phone:307-672-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
459818133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered