Provider Demographics
NPI:1164579256
Name:CONYER, KATHY C (RD,LD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:C
Last Name:CONYER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 COUNTY ROAD 811
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-2711
Mailing Address - Country:US
Mailing Address - Phone:936-645-6965
Mailing Address - Fax:
Practice Address - Street 1:651 COUNTY ROAD 811
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-2711
Practice Address - Country:US
Practice Address - Phone:936-645-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX833445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered